Corticosteroid therapy in patients with IgA nephropathy and impaired renalfunction

Aim: IgA nephropathy (IgAN) is a common type of primary glomerulone nephrit is that constitutes a major cause of end-stage renal disease. Oral and/or i ntravenous glucocorticoid therapy can protect against progression of IgAN i n patients with preserved renal function. We evaluated steroid therapy in I gAN with established renal dysfunction. Patients and methods: We retrospect ively analyzed the effect of methylprednisolone (MP) pulse therapy in 8 IgA N patients with serum creatinine concentrations (sCr) 2.76 +/- 1.32 mg/dl ( mean +/- SD). In each patient renal function had progressively deteriorated in the 12 months preceding treatment, as indicated by negative slopes of 1 /sCr plotted against time (regression coefficients). Results: Regression co efficients during the 12 months following therapy improved significantly fr om -0.02333 +/- 0.00732 to -0.00036 +/- 0.00423 dl/mg/month, respectively. The mean difference in slope was 0.0230 +/- 0.0076 dl/mg/month (95% confide nce interval, 0.0165 to 0.0295, p < 0.001). Proteinuria also significantly decreased from a mean urine protein/creatinine ratio of 2.57 +/- 1.12 befor e therapy to 1.12 +/- 0.84 6 months after therapy (p < 0.005). Other factor s that might affect progression of renal dysfunction remained unchanged dur ing the observation periods. Conclusion: Corticosteroids may attenuate prog ression of renal failure and delay the need for dialysis in this patient po pulation, although a large randomized trial is necessary.