基线蛋白尿和估计GFR对IgA肾病的皮质类固醇作用

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports Pub Date : 2025-06-01 DOI:10.1016/j.ekir.2025.03.008

Dana Kim , Brendon L. Neuen , Jicheng Lv , Michelle A. Hladunewich , Vivekanand Jha , Lai Seong Hooi , Helen Monaghan , Robert A. Fletcher , Laurent Billot , Vlado Perkovic , Hong Zhang , Muh Geot Wong

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引用次数: 0

摘要

较高的蛋白尿和较低的肾小球滤过率（eGFR）是IgA肾病（IgAN）肾衰竭的预测因子；然而，尚不确定这些标志物是否会改变对皮质类固醇的反应。这项测试的事后分析评估了甲基强的松龙对肾脏的影响以及基线蛋白尿和eGFR的安全性结果。方法将503例IgAN和蛋白尿≥1 g/d的受试者随机分为口服甲泼尼龙组（全剂量0.6-0.8 mg/kg/d或减量0.4 mg/kg/d）和安慰剂组。参与者根据基线蛋白尿(1 -<；1.5、1.5 & lt;3,≥3g /d)和eGFR (20 -<；30、30 & lt;45岁,45 & lt;60, 60 - 120毫升/分钟每1.73平方米)。结果在平均4.2年的随访中，甲基泼尼松龙降低了47%的主要结局（eGFR下降≥40%、肾衰竭或因肾脏疾病死亡）的风险（风险比：0.53,95%可信区间[CI]: 0.39-0.72），无论基线蛋白尿（p -相互作用= 0.53）或eGFR （p -相互作用= 0.68）的影响都是一致的。同样，甲基强的松龙改善了总eGFR斜率的下降和蛋白尿的减少，无论基线蛋白尿或eGFR(所有p相互作用>；0.10)。在所有蛋白尿和eGFR水平下，甲泼尼龙组的严重不良事件（sae）数量高于安慰剂组。绝对益处和危害因eGFR而异，例如对于那些eGFR和lt；30毫升/分钟每1.73平方米，绝对风险的SAEs可能超过潜在的优势。然而，这个亚组很小，主要接受全剂量甲基强的松龙治疗，并且比eGFR≥30 ml/min / 1.73 m2的患者更老。结论：甲强的松龙可改善进展风险较高的IgAN患者的肾脏预后，无论是否有蛋白尿或eGFR，尽管在疾病晚期加上其他皮质类固醇相关毒性危险因素的患者中，风险-收益平衡可能不太有利。

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Corticosteroid Effects in IgA Nephropathy by Baseline Proteinuria and Estimated GFR

Introduction

Higher proteinuria and lower estimated glomerular filtration rate (eGFR) are predictors of kidney failure in IgA nephropathy (IgAN); however, it is uncertain whether these markers modify response to corticosteroids. This post hoc analysis of the TESTING trial assessed the effects of methylprednisolone on kidney and safety outcomes by baseline proteinuria and eGFR.

Methods

A total of 503 participants with IgAN and proteinuria ≥ 1 g/d were randomized to oral methylprednisolone (full-dose 0.6–0.8 mg/kg/d or reduced-dose 0.4 mg/kg/d) versus placebo. Participants were categorized according to baseline proteinuria (1–< 1.5, 1.5–< 3, ≥ 3 g/d) and eGFR (20–< 30, 30–< 45, 45–< 60, 60–120 ml/min per 1.73 m²).

Results

Over a mean follow-up of 4.2 years, methylprednisolone lowered the risk of the primary outcome (≥ 40% decline in eGFR, kidney failure, or death because of kidney disease) by 47% (hazard ratio: 0.53, 95% confidence interval [CI]: 0.39–0.72), with consistent effects regardless of baseline proteinuria (P-interaction = 0.53) or eGFR (P-interaction = 0.68). Similarly, methylprednisolone improved the decline in total eGFR slope and reduced proteinuria, regardless of baseline proteinuria or eGFR (all P-interaction > 0.10). The number of serious adverse events (SAEs) was higher with methylprednisolone than with placebo across all proteinuria and eGFR levels. Absolute benefits and harms varied by eGFR, such that for those with eGFR < 30 ml/min per 1.73 m², absolute risk of SAEs may outweigh potential advantages. However, this subgroup was small, predominantly received full-dose methylprednisolone, and was older than those with eGFR ≥ 30 ml/min per 1.73 m².

Conclusion

Methylprednisolone improves kidney outcomes in IgAN at high risk of progression, irrespective of proteinuria or eGFR, although the risk-benefit balance may be less favorable in those with advanced disease plus other risk factors for corticosteroid-related toxicities.

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来源期刊

Kidney International Reports Medicine-Nephrology

CiteScore

7.70

自引率

3.30%

发文量

1578

审稿时长

8 weeks

期刊介绍： Kidney International Reports, an official journal of the International Society of Nephrology, is a peer-reviewed, open access journal devoted to the publication of leading research and developments related to kidney disease. With the primary aim of contributing to improved care of patients with kidney disease, the journal will publish original clinical and select translational articles and educational content related to the pathogenesis, evaluation and management of acute and chronic kidney disease, end stage renal disease (including transplantation), acid-base, fluid and electrolyte disturbances and hypertension. Of particular interest are submissions related to clinical trials, epidemiology, systematic reviews (including meta-analyses) and outcomes research. The journal will also provide a platform for wider dissemination of national and regional guidelines as well as consensus meeting reports.