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Abstract: PO1835

IgA Nephropathy Study: A Multicentric Study in Portugal

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Santos, Sofia, Centro Hospitalar Universitario do Porto EPE, Porto, Porto, Portugal
  • Malheiro, Jorge, Centro Hospitalar Universitario do Porto EPE, Porto, Porto, Portugal
  • Gomes, Ana Marta, Centro Hospitalar de Gaia / Espinho, Gaia, Portugal

Group or Team Name

  • Grupo de Estudo da Nefropatia de IgA e Nefropatia Membranosa em Portugal (ENIGAM), Sociedade Portuguesa de Nefrologia, Portugal
Background

In the last decade, an attempt to correlate the histopathological lesions with renal prognosis in IgA Nephropathy (IgAN) was developed in order to identify patients that benefit from IS therapy.

Methods

A multicentric, longitudinal and retrospective (2007-2019) study was developed in Portugal: adult patients with histological diagnosis of IgAN. Biopsy date defined study entrance and data was collected.

Results

167 patients were analyzed. The coorte was divided in 2, according the use of steroid therapy: 105 in group of no steroids (noCST) and 62 in the group with steroids (wCST). Endocapillary hypercellularity (29% vs 16%, p=0.049) and crescents 34% vs 10%, p<0.001), were significantly more frequent is wCST group. Median time until the beginning of steroids was 55 days (IQR 7-251), and tmedian duration was 195 days (IQR 96-239). Follow up time was 39 months (IQR 15.1-65.8), significantly superior in wCST group (56.6 vs 29.8 months,p=0.004). No difference between groups considering infections, AKI, CV disease or death. Renal survival at 7 years was 70% at noCST group and 85% at wCST group, p=0.184. Multivariable analysis identified HT (OR 3.81), proteinuria (OR 2.80) and crescents (OR 2.72) as significant factors associated with steroids use. Table 1 defines the independent predictors for ESRD (Cox regression analysis). When we analyze the steroids effect on renal survival, we saw that the average time until renal replacement therapy (RRT) was 47.7 months (IQR 34.6-60.7) in noCST group and 81.6 months (IQR 63.8-99.3) in wCST group. The average treatment effect with steroids was 33.9 months (11.9-55.9, p=0.002), that means that if we treat all, this was the time that we could delay beginning of RRT.

Conclusion

In this group of patients, use of steroids was an independent predictor for delaying CKD progression and the beginning of RRT. HT, degree of proteinuria and crescents presence were significant predictors for its use. In spite of the controversy about the use of steroids therapy in IgAN, this study showed their effectiveness without risk increase.

 HR (95% CI)P
Steroids0.318 (0.120-0.842)0.021
IFTA (by unit)2.105 (1.207-3.671)0.009
Crescents, by unit2.438 (1.309-4.543)0.005
Endocapilar hypercelullarity1.032 (1.001-1.065)0.044
eGFR (mL/min)0.990 (0.980-0.999)0.032
Age (years)0.991 (0.982-0.999)0.041