USE OF CORTICOSTEROIDS IN A NORWEGIAN COHORT OF PATIENTS WITH IGA NEPHROPATHY AND RAPID PROGRESSION TO END-STAGE RENAL DISEASE

Abstract BACKGROUND AND AIMS Despite several clinical trials, treatment with corticosteroids in patients with Immunoglobulin A nephropathy (IgAN) remains controversial [1, 2]. The recently updated KDIGO guidelines suggests that treatment with corticosteroids could be considered in patients with persistent proteinuria above 0.75 to 1.0 g per day in patients with estimated glomerular filtration rate (eGFR) above 30 mL/min/1.73 m2 despite intensive supportive care [3]. This is a more liberal approach compared with the 2012 guidelines, which suggested that patients selected for treatment with steroids should have eGFR above 50 mL/min/1.73 m2 [4]. It could be valuable to identify clinicians decision on when to initiate immunosuppressive treatment, since this could have implication on how future therapeutics might be used in patients with IgAN [5]. Our aim is to describe the use of corticosteroids and evaluate the effect of this treatment using a Norwegian cohort of patients with IgAN. METHOD We identified patients with biopsy-proven IgAN from the Norwegian Kidney Biopsy Registry and the Norwegian Renal Registry, who all had progressed to end-stage renal disease (ESRD) and collected clinical, treatment and biochemical data from patient records. RESULTS A total of 151 patients with a diagnostic kidney biopsy performed between 1988 and 2010 were included. The median time from biopsy to ESRD was 5 years. A majority of 94% of the patients received supportive treatment with Renin–Angiotensin–Aldosterone System blockade. A total of 40 patients (27%) received treatment with corticosteroids, with a median eGFR and proteinuria at time of biopsy at 49.5 mL/min/1.73 m2 and 5.1 g per day, respectively. Median time from biopsy to steroid treatment was 12 months. Patients treated with corticosteroids had a significant decrease in proteinuria from 5.6 to 3 g per day (P = .02), but there was no difference in time to progression to ESRD between the two groups (P = .58). The vast majority (87.5%) of the patients treated with corticosteroids reported on adverse events. CONCLUSION We found that the use of corticosteroids had significant impact on proteinuria but did not delay progression to ESRD. Adverse events were common in patients treated with corticosteroids. The patients were treated according to the current guidelines