Retrospective analysis of glucocorticoid therapy in pediatric immunoglobulin A nephropathy: Kidney outcomes and efficacy.

IF 2.6 3区 医学 Q1 PEDIATRICS
Pediatric Nephrology Pub Date : 2025-11-01 Epub Date: 2025-07-15 DOI:10.1007/s00467-025-06845-8
Heyan Wu, Zhengkun Xia, Lidan Zhang
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引用次数: 0

Abstract

Background: The efficacy of glucocorticoid (GC) in the management of immunoglobulin A nephropathy (IgAN) remains highly controversial. The study was conducted to analyze the efficacy and kidney outcomes of GC in the treatment of pediatric IgAN.

Methods: Using the follow-up data of children with chronic kidney disease from the Department of Pediatrics at Jinling Hospital between January 2000 and December 2020, we selected children with primary IgAN who were ≤ 18 years old, confirmed by kidney biopsy, and had undergone regular follow-up for more than 2 years. Patients who had previously used other immunosuppressive agents or had not received renin-angiotensin system blocker (RASB) treatment were excluded. The selected patients were divided into two groups based on their prior treatment regimens: the GC + RASB group and the RASB group. The primary outcome was a composite of a 40% decrease in estimated glomerular filtration rate (eGFR) from baseline, kidney failure, or death due to kidney disease.

Results: A total of 374 patients (149 females) were enrolled, with 230 in the GC + RASB group and 144 in the RASB group. At baseline, the GC + RASB group had lower albumin and higher creatinine levels (all P < 0.05). From 6 months of treatment, the GC + RASB group showed higher urinary protein remission rates (P < 0.05), but hematuria relief was similar between groups. Adverse events, including centripetal obesity, were more frequent in the GC + RASB group (P = 0.001). After a median follow-up of 130.97 months, the GC + RASB group had fewer endpoint events (5.22% vs. 11.11%, P = 0.035) and higher cumulative kidney event-free survival rates, particularly in patients with eGFR > 50 ml/min/1.73 m2 and 24 h-UP ≥ 1 g/d (all P < 0.05).

Conclusions: GC therapy reduced the risk of progression to kidney failure in children with initial eGFR > 50 ml/min/1.73 m2 and proteinuria ≥ 1 g/d. No additional kidney event-free survival benefit was observed in children with eGFR ≤ 50 ml/min/1.73 m2 or proteinuria < 1 g/d.

儿童免疫球蛋白A肾病糖皮质激素治疗的回顾性分析:肾脏预后和疗效。
背景:糖皮质激素(GC)治疗免疫球蛋白A肾病(IgAN)的疗效仍有很大争议。本研究旨在分析GC治疗小儿IgAN的疗效和肾脏预后。方法:利用2000年1月至2020年12月金陵医院儿科慢性肾病患儿的随访资料,选择年龄≤18岁、经肾活检证实的原发性IgAN患儿,定期随访2年以上。先前使用其他免疫抑制剂或未接受肾素-血管紧张素系统阻滞剂(RASB)治疗的患者被排除在外。选取的患者根据既往治疗方案分为两组:GC + RASB组和RASB组。主要终点是肾小球滤过率(eGFR)较基线降低40%、肾功能衰竭或肾脏疾病导致的死亡。结果:共纳入374例患者(女性149例),其中GC + RASB组230例,RASB组144例。在基线时,GC + RASB组有较低的白蛋白和较高的肌酐水平(所有P均为50 ml/min/1.73 m2和24 h- P≥1 g/d)。结论:GC治疗降低了初始eGFR为50 ml/min/1.73 m2和蛋白尿≥1 g/d的儿童进展为肾衰竭的风险。在eGFR≤50 ml/min/1.73 m2或蛋白尿的儿童中,没有观察到额外的无肾事件生存获益
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来源期刊
Pediatric Nephrology
Pediatric Nephrology 医学-泌尿学与肾脏学
CiteScore
4.70
自引率
20.00%
发文量
465
审稿时长
1 months
期刊介绍: International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.
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