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

Glomerular diseases Pub Date : 2025-03-20 eCollection Date: 2025-01-01 DOI:10.1159/000545382

Bancha Satirapoj, Thapana Chueaboonchai, Naowanit Nata, Ouppatham Supasyndh

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Abstract

Introduction: 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.

Objective: This study aimed to evaluate the efficacy of steroid treatment in IgA nephropathy patients classified according to the Oxford-MEST-C classification.

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

Results: Overall, 68.7% of patients received treatment with corticosteroids. The median estimated GFR decline was significantly lower in the steroid group compared to the controls {-0.65 (interquartile range [IQR] -3.45 to 7) vs. -5.75 (IQR -10.65 to -0.7) mL/min/1.73 m²/year, p = 0.025}. The slope of estimated GFR was also significantly different between the steroid and control groups in patients with a 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), mesangial hypercellularity M0 score (4.69 ± 11.37 vs. -2.63 ± 6.42 mL/min/1.73 m²/year, p = 0.049), and C0 score (2.48 ± 12.63 vs. -5.58 ± 8.4 mL/min/1.73 m²/year, p = 0.026). Additionally, rapid GFR decline (>5 mL/min/1.73 m²/year) occurred in 9 patients (19.6%) in the steroid group compared with 11 participants (52.4%) in the control group (p = 0.006).

Conclusion: Corticosteroid therapy, in addition to optimized RAAS inhibition, lowers the risk of kidney disease progression in patients with IgA nephropathy, particularly those with a baseline GFR >50 mL/min/1.73 m² and those classified with Oxford scores M0 and C0.

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根据Oxford-MEST-C分级，IgA肾病皮质类固醇治疗的肾脏预后。

导论：尽管优化了肾素-血管紧张素-醛固酮系统（RAAS）抑制，IgA肾病患者仍然存在肾衰竭的风险。类固醇对不同肾脏病理病变的IgA肾病患者肾脏预后的影响尚不确定。目的：本研究旨在评价类固醇治疗按Oxford-MEST-C分级的IgA肾病患者的疗效。方法：我们回顾性研究了67例活检证实的IgA肾病患者，这些患者在2016年1月至2020年12月期间接受了优化的RAAS抑制剂治疗，并有持续的蛋白尿bbb10 1 g/天。临床参数，包括估计肾小球滤过率（GFR）下降，比较皮质类固醇和支持治疗组之间。结果：总体而言，68.7%的患者接受了皮质类固醇治疗。与对照组相比，类固醇组GFR下降的中位数显著降低{-0.65（四分位数范围[IQR] -3.45至7）vs -5.75 (IQR -10.65至-0.7)mL/min/1.73 m2/年，p = 0.025}。基线GFR >50 mL/min/1.73 m2（3.90±11.42 vs -9.31±5.08 mL/min/1.73 m2/年，p = 0.011）、系膜高细胞M0评分（4.69±11.37 vs -2.63±6.42 mL/min/1.73 m2/年，p = 0.049）和C0评分（2.48±12.63 vs -5.58±8.4 mL/min/1.73 m2/年，p = 0.026）患者的估计GFR斜率在类固醇组和对照组之间也有显著差异。此外，类固醇组中有9名患者（19.6%）发生GFR快速下降（5 mL/min/1.73 m2/年），而对照组中有11名患者（52.4%）（p = 0.006）。结论：皮质类固醇治疗，除了优化的RAAS抑制外，降低了IgA肾病患者肾脏疾病进展的风险，特别是那些基线GFR bb0为50 mL/min/1.73 m2和牛津评分为M0和C0的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Glomerular diseases

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