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Abstract: PO1836

Corticosteroid Therapy Improves Renal Prognosis in IgAN Patients with Crescent

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Matsuzaki, Keiichi, Kyoto University Health Service, Kyoto, Japan
  • Suzuki, Hitoshi, Juntendo University Faculty of Medicine, Tokyo, Tokyo, Japan
  • Imai, Takumi, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
  • Aida, Rei, Graduate school of medicine Kyoto University, Kyoto, Kyoto, Japan
  • Barbour, Sean, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  • Cattran, Daniel C., Toronto General Hospital, Toronto, Ontario, Canada
  • Katafuchi, Ritsuko, National Hospital Organization Fukuoka HIgashi Medical Center, Fukuoka, Fukuoka, Japan
  • Suzuki, Yusuke, Juntendo University Faculty of Medicine, Tokyo, Tokyo, Japan
Background

IgA nephropathy (IgAN) has been identified as having an inflammatory basis leading to the biological rationale of immunosuppressive therapy. However, little is known about the clinical indication of immunosuppressive therapy related to each histological finding. Recently, Haas et al reported that the crescent lesion is an independent predictor for renal survival in IgAN especially with no immunosuppressive therapy. We assessed the effect of corticosteroid therapy on renal survival of IgAN with crescent based on the Japanese dataset used in the recently published IgAN prediction tool from multinational multi-ethnic cohort (Barbour SJ, JAMA Intern Med. 2019), given it was almost all corticosteroids.

Methods

We extracted the 566 Japanese adults with biopsy-proven IgAN patients (male 45.9%, median age 34.7) from original cohort. Baseline characteristics were evaluated at the biopsy, and clinical data including serum creatinine, urinary findings, use of RAS blockers (RASB) and corticosteroid therapy and tonsillectomy were collected at every visit. The outcome was defined as 50% decline in eGFR or end-stage kidney disease. Cox proportional hazard models were used to investigate the association between corticosteroid therapy and renal survival with adjustments of confounders including the Oxford classification. Treatment options were included in the model as time-dependent covariates.

Results

At biopsy, median eGFR and proteinuria and proportions of the patients with crescent were 73.2ml/min/1.73m2, 0.67g/day, and 59.9%, respectively. During a median follow-up of 3.79 years, 57 patients (10.1%) reached the outcome. RASB and corticosteroid were used in 377 patients (66.6%) and 368 patients (65.0%), respectively. 241 (42.6%) patients were performed tonsillectomy. Hazard ratio (HR) of corticosteroid therapy was reversed by presence of crescent (no crescent: HR 1.75 95% confidence interval [CI] 0.72-4.23, presence of crescent: HR 0.26 95%CI 0.11-0.61), indicating the interaction between corticosteroid therapy and presence of crescent (p<0.001). Tonsillectomy had also a favorable effect on renal survival (HR 0.43 95%CI 0.20-0.91).

Conclusion

Present findings revealed that corticosteroid therapy improved renal survival in Japanese IgAN patients with crescent and are thus suggestive for the indication of this therapy.