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Kidney Week

Abstract: SA-PO889

Kidney Outcomes with Corticosteroid Treatment in IgA Nephropathy According to the Oxford-MEST-C Classification

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Satirapoj, Bancha, Phramongkutklao College of Medicine, Bangkok, Thailand
  • Chueaboonchai, Thapana, Phramongkutklao College of Medicine, Bangkok, Thailand
  • Siriwattanasit, Narongrit, Phramongkutklao College of Medicine, Bangkok, Thailand
  • Varothai, Narittaya, Phramongkutklao College of Medicine, Bangkok, Thailand
  • Nata, Naowanit, Phramongkutklao College of Medicine, Bangkok, Thailand
  • Tangwonglert, Theerasak, Phramongkutklao College of Medicine, Bangkok, Thailand
  • Chaiprasert, Amnart, Phramongkutklao College of Medicine, Bangkok, Thailand
  • Supasyndh, Ouppatham, Phramongkutklao College of Medicine, Bangkok, Thailand
Background

Despite optimization of renin-angiotensin-aldosterone system (RAAS) inhibition, patients with IgA nephropathy remain at risk for kidney failure. The effect of steroids on kidney outcomes in IgA nephropathy with different renal pathologic lesions has been uncertain.

Methods

We retrospectively studied 67 patients with biopsy-proven IgA nephropathy who were receiving optimized RAAS inhibitor therapy and persistent proteinuria > 1 g/day between January 2016 and December 2020. Clinical parameters including estimated glomerular filtration rate (GFR) decline were compared between corticosteroids and supportive treatment.

Results

Overall, 68.7% of patients received treatment with corticosteroids. Median estimated GFR decline was significantly lower in the steroids than in the controls (-0.65 (IQR 7 to -3.45) vs - 5.75 (IQR -0.7 to -10.65) mL/min/1.73 m2/year, P=0.025, respectively). Slope of estimated GFR were also significantly different between the steroids and the controls in subgroup of patients with baseline GFR >50 mL/min/1.73 m2 (3.90±11.42 vs -9.31±5.08 mL/min/1.73 m2/year, P=0.011, respectively), mesangial hypercellularity M0 score (4.69±11.37 vs -2.63±6.42 mL/min/1.73 m2/year, P=0.049, respectively), and C0 score (2.48±12.63 vs -5.58±8.4 mL/min/1.73 m2/year, P=0.026, respectively). In additionally, the rapid GFR decline >5 mL/min/1.73 m2/year occurred in 9 (19.6%) in the steroids compared with 11 participants (52.4%) in the controls (P=0.006).

Conclusion

Corticosteroids therapy in addition to optimized RAAS inhibition has lower the risks of kidney disease progression in patients with IgA nephropathy especially baseline GFR >50 mL/min/1.73 m2, Oxford classification M0 and C0 score.