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Kidney Week

Abstract: SA-PO897

Mycophenolate Mofetil (MMF) and Corticosteroids in Crescentic IgA Nephropathy (IgAN)

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Vargas-Brochero, Maria Jose, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Machado, Miriam, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Valencia-Morales, Nancy Daniela, Hospital Clinico San Carlos, Madrid, Comunidad de Madrid, Spain
  • Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Radhakrishnan, Yeshwanter, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Soler, Maria Jose, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
  • Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

There is no gold standard for the treatment of crescentic IgAN.

Methods

Biopsy-proven crescentic IgAN patients treated with MMF plus corticosteroids 2000-2022(Figure1).Renal outcomes analyzed: hematuria, proteinuria,estimated glomerular filtration rate(eGFR),and end-stage kidney disease(ESKD) after one year.

Results

A total of 22 patients ,72.7% male,86.4% white, age 38.9±15.3 years. Follow-up 3.9±2 years. Baseline serum creatinine(sCr)2.0±0.78mg/dl,and 100% had hematuria. Kidney biopsy showed(MEST, M1 [90.9%], E1 [59.1%] ,S1[86.4%] ,T0[59.1%], T1[27.3%], T2[13.6%], C1[72.7%], C2[27.3%]).95.4% no previous immunosuppression,77.3% Intravenous methylprednisolone,and 100% received oral corticosteroids, time biopsy to MFF 19 [IQR3.5-69.5] days.
At one-year, kidney survival 100%, hematuria disappeared in 68.4%, eGFR(CKD-EPI) increased from 35.6[IQR24.7-71.5] to 51.3[IQR36.4-87]ml/min/1.73m2(p=0.003), proteinuria g/24h decreased from 1.8[IQR 1.2-4.0] to 0.55 [IQR0.2-1.3](p=0.003).The renal survival with IFTA≥40% was 40% vs. 88.2%with IFTA<40%. Persistent hematuria(PH) had a renal survival of 50% vs. 92.3% with no PH.Most common adverse event was infection(n=6), with temporary treatment discontinuation.22.7% developed ESKD.

Conclusion

MMF plus corticosteroids is associated with 100% kidney survival at one year and 77.3% at the end of follow-up. Advanced interstitial fibrosis and PH seem to be associated with worse prognosis in crescentic IgAN.