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Abstract: SA-PO888

Utilization of Corticosteroid Therapy in Patients with IgA Nephropathy and C1 Lesion

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Cabrales, Jose, Stanford Medicine, Stanford, California, United States
  • Charu, Vivek, Stanford Medicine, Stanford, California, United States
  • Shaw, Blake, Stanford Medicine, Stanford, California, United States
  • Lafayette, Richard A., Stanford Medicine, Stanford, California, United States
Background

IgA nephropathy (IgAN) frequently leads to chronic kidney disease and progressive kidney failure. Among the prognostic factors is the presence of crescents on kidney biopsy, as a component of the MEST-C score, leading many to consider steroid treatment when crescents are found, even when seen in mild to moderate numbers (1-25%, C1 lesion). We wanted to assess if steroid treatment does indeed impact the outcome of IgAN patients with crescents.

Methods

Retrospective review of patient records from 2017-2022 who had biopsy proven IgAN with C1 lesions and adequate follow up was undertaken to assess patient characteristics, treatment and longitudinal follow up of outcomes of changes in eGFR and proteinuria. A multivariate model was created to relate steroid therapy to short to moderate term changes in kidney function (by eGFR slope).

Results

68 of 176 consecutive patients met the study criteria, they had an average age of 41 years, 57% were women, mostly Asian, variable activity and chronicity in MEST score. Median (IQR) of crescent percent was 8.5(4.8-14.2%), UPCR median was 1.78g/g, eGFR mean (SD) was 63±36 ml/min/1.73m2. Average follow up was 2 years. Most patients (75%) had been treated with renin-angiotensin system inhibitors. 37 of the patients underwent steroid therapy shortly after biopsy. There were differences in age, gender and MESTC score between treated and untreated patients. There were variable impacts on proteinuria. Utilizing linear mixed effects modeling, there was no significant difference between treated and untreated patients in their annual decline in eGFR, which averaged 2.13 ml/min/year (difference in slopes [treated v. untreated] of 0.70 ml/min/year, p=0.35).

Conclusion

Patients with IgAN and C1 lesions are frequently treated with corticosteroid therapy after kidney biopsy. In this predefined cohort, steroid therapy provided a non-significant trend for less disease progression over this follow up. Larger cohorts should be followed for longer periods of time, but presently, it does not appear prudent to choose steroid therapy based on C1 lesions seen on the biopsy.

Funding

  • Private Foundation Support