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Kidney Week

Abstract: SA-PO896

Mycophenolate Mofetil in Steroid Nonresponsive IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Bagchi, Soumita, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Subbiah, Arunkumar, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Yadav, Raj Kanwar, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Mahajan, Sandeep, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Bhowmik, Dipankar M., All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Agarwal, Sanjay K., All India Institute of Medical Sciences, New Delhi, Delhi, India
Background

Immunosuppression use is suggested in patients of primary IgA nephropathy (IgAN) with persistent proteinuria≥1 g/day. We examined the role of mycophenolate mofetil (MMF) in steroid non-responsive IgAN.

Methods

In a retrospective study (2012-21) we included patients with primary IgAN who had received MMF for persistent proteinuria(≥1g/day) despite treatment with oral steroids(1mg/kg/day) for at-least 8 weeks. All patients had received MMF 1-2g/day for at-least 3 months. Patients with C2 lesions were excluded. Primary outcome was deterioration of renal function defined as sustained decline in estimated glomerular filtration rate(eGFR) by > 50% documented during at-least 2 consecutive clinic visits with no recovery or progression to end stage kidney disease. Complete remission (CR) was defined as proteinuria <500 mg/d with stable eGFR and partial remission (PR) as proteinuria<1g/day, at-least 50% reduction in proteinuria and decline of proteinuria to <3.5g/day with stable eGFR.

Results

81 patients were included. Median age at presentation was 32(IQR 25-42) years and 67.9% were males. 67.9% had hypertension. 68(84%) had M1, 12(14.8%) had E1, 58(71.6%) had S1, 37(45.7%) had T1, 5(6.2%) had T2 and 16(19.8%) had C1 lesions. Median eGFR was 46.3(IQR 37.6-67.0) ml/min/173m2, median serum albumin was 3.9(IQR 3.4-4.3) g/dl and median proteinuria was 3.5(IQR 2.1-4.4) g/day at time of initiating MMF treatment.
70(90.1%) cases received renin angiotensin system (RAS) blockade therapy. 44(54.3%) patients achieved remission with MMF therapy (CR:24, PR:20) of whom 12/44(27.3%) relapsed. During a median follow up of 52.2 (IQR 30.8 to 69.1) months after diagnosis, 35(43.2%) patients had progressed to primary outcome. 35(43.2%) patients had adverse effects, 4 had diarrhea and 31 had infections.7 patients developed tuberculosis.

Conclusion

MMF has limited efficacy in steroid non-responsive IgAN but with significant adverse effects.