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Abstract: SA-PO894

Mycophenolate Mofetil and Steroid for Treatment of Patients with IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Miao, Jing, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Duriseti, Parikshit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Radhakrishnan, Yeshwanter, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Vaughan, Lisa E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

The efficacy of steroids and mycophenolate mofetil (MMF) treatment in patients with IgA nephropathy (IgAN) is the subject of ongoing debate. We retrospectively evaluated the effects of MMF+steroid treatment compared to steroid alone or conservative therapy on incident kidney failure in adults with biopsy proven IgAN.

Methods

The study population was derived from biopsy proven adult IgAN patients seen at Mayo Clinic Rochester from 1/1/2008 to 12/31/2018. Patients were categorized into treatment groups based on which therapy they received within the first 3 months following kidney biopsy. The association between treatment group and risk of incident kidney failure was evaluated using Cox proportional hazards regression models using inverse probability of treatment weighted (IPTW) estimation with propensity scores to control for pre-treatment imbalances on observed variables.

Results

A total of 166 patients were included in the final analysis, with 30 (18%) patients developing incident kidney failure during a mean follow-up of 6.2 years. The conservative group exhibited lower levels of serum creatinine, degree of hematuria, and histopathological M, E, and C scores when compared to the treated groups. Conversely, the conservative group demonstrated higher eGFR compared to the treated patients (Table 1). The incidence of kidney failure was significantly reduced by 88% in patients who received MMF+steroid therapy compared to those who underwent conservative therapy (HR 0.12, 95% CI 0.02, 0.95, p=0.04). Although patients who received steroids alone were also less likely to experience kidney failure compared to conservative therapy, the results did not reach statistical significance (HR 0.50, 95% CI 0.19, 1.36, p=0.17).

Conclusion

Our data suggests that combined therapy of MMF+steroid could be a promising treatment strategy for white IgAN patients, particularly those with active inflammatory lesions on kidney biopsy.