Corticosteroid Treatment Influences TA-Proteinuria and Renal Survival in IgA Nephropathy

• Published in: PloS one Vol. 11; no. 7; p. e0158584
• Main Authors: Sarcina, Cristina, Tinelli, Carmine, Ferrario, Francesca, Visciano, Bianca, Pani, Antonello, De Silvestri, Annalisa, De Simone, Ilaria, Del Vecchio, Lucia, Terraneo, Veronica, Furiani, Silvia, Santagostino, Gaia, Corghi, Enzo, Pozzi, Claudio
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.07.2016; Public Library of Science (PLoS)
• Subjects: Adolescent; Adrenal Cortex Hormones - pharmacology; Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Azathioprine; Azathioprine - pharmacology; Azathioprine - therapeutic use; Biology and Life Sciences; Biometrics; Biopsy; Blood pressure; Clinical trials; Complications and side effects; Corticoids; Corticosteroid drugs; Corticosteroids; Creatinine; Creatinine - blood; Dosage and administration; Drug therapy; Drug Therapy, Combination; Enzymes; Epidemiology; Female; Follow-Up Studies; Glomerulonephritis, IGA - blood; Glomerulonephritis, IGA - drug therapy; Glomerulonephritis, IGA - pathology; Hemodialysis; Humans; IgA nephropathy; Immunoglobulin A; Kidney - drug effects; Kidney - pathology; Kidney diseases; Kidney failure; Kidney Function Tests; Lesions; Male; Medical prognosis; Medical research; Medical treatment; Medicine and Health Sciences; Middle Aged; Multivariate analysis; Nephrology; Patients; Physical Sciences; Proteinuria; Proteinuria - blood; Proteinuria - drug therapy; Proteinuria - pathology; Renal function; Renal insufficiency; Research and Analysis Methods; Retrospective Studies; Risk analysis; Risk factors; Steroids; Studies; Survival; Therapy; Treatment Outcome; Young Adult; Italy
• DOI: 10.1371/journal.pone.0158584
• ISSN: 1932-6203

The clinical course of IgA nephropathy (IgAN) and its outcome are extremely variable. Proteinuria at baseline has been considered one of the most important risk factors. More recently, mean proteinuria of follow-up (time-average proteinuria: TAp) was described as a stronger marker of renal survival, suggesting to consider it as a marker of disease activity and response to treatment. We evaluated predictors of renal survival in IgAN patients with different degrees of renal dysfunction and histological lesions, focusing on the role of the therapy in influencing TAp. We performed a retrospective analysis of three prospective, randomized, clinical trials enrolling 325 IgAN patients from 1989 to 2005. Patients were divided into 5 categories according to TAp. The primary endpoint of the 100% increase of serum creatinine occurred in 54 patients (16.6%) and renal survival was much better in groups having lower TAp. The median follow up was 66.6 months (range 12 to 144). The primary endpoint of the 100% increase of serum creatinine occurred in 54 patients (16,6%) and renal survival was much better in groups having lower TA proteinuria. At univariate analysis plasma creatinine and 24h proteinuria, systolic (SBP) and diastolic (DBP) blood pressure during follow-up and treatment with either steroid (CS) or steroid plus azathioprine (CS+A) were the main factors associated with lower TAp and renal survival. At multivariate analysis, female gender, treatment with S or S+A, lower baseline proteinuria and SBP during follow-up remained as the only variables independently influencing TAp. In conclusion, TA-proteinuria is confirmed as one of the best outcome indicators, also in patients with a severe renal insufficiency. A 6-month course of corticosteroids seems the most effective therapy to reduce TAp.