Corticosteroids pulse therapy and oral corticosteroids therapy for IgA nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort study
Abstract Background Corticosteroids are widely used to reduce the urine protein levels of patients with immunoglobulin A nephropathy (IgAN). However, their potential preventive effects on end-stage kidney disease (ESKD) are unclear. Methods We previously performed a large-scale, long-term multicente...
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doaj-c40728c6194144168592be850a0b347e2020-11-24T21:36:01ZengBMCBMC Nephrology1471-23692018-09-011911610.1186/s12882-018-1019-xCorticosteroids pulse therapy and oral corticosteroids therapy for IgA nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort studyRyoya Tsunoda0Joichi Usui1Junichi Hoshino2Takayuki Fujii3Satoshi Suzuki4Kenmei Takaichi5Yoshifumi Ubara6Kunihiro Yamagata7Department of Nephrology, Faculty of Medicine, University of TsukubaDepartment of Nephrology, Faculty of Medicine, University of TsukubaNephrology Center, Toranomon HospitalDepartment of Nephrology, Seirei Sakura Citizen HospitalDepartment of Nephrology, Seirei Sakura Citizen HospitalNephrology Center, Toranomon Hospital KajigayaNephrology Center, Toranomon HospitalDepartment of Nephrology, Faculty of Medicine, University of TsukubaAbstract Background Corticosteroids are widely used to reduce the urine protein levels of patients with immunoglobulin A nephropathy (IgAN). However, their potential preventive effects on end-stage kidney disease (ESKD) are unclear. Methods We previously performed a large-scale, long-term multicenter cohort study of patients with biopsy-proven IgAN treated between 1981 and 2013 (n = 1923). Based on the results, we reported that corticosteroids pulse therapy was potentially effective for the treatment of patients with an eGFR ≥30 ml/min/1.73m2 and a urine protein amount of ≥1 g/gCr. In the present study, we extracted 766 patients with chronic kidney disease (CKD), stage G3–G4 (15 ≤ estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73m2) from the same cohort. We divided these patients into a steroid pulse (SP) group, oral steroid (OS) group, and no steroid (NS) group, and analyzed the risk of end-stage kidney disease (ESKD) stratified by eGFR and urine protein (UP) amounts. Results Over the median long-term follow-up of 70 ± 115 months, 37.1% of the patients with UP ≥1.0 g/day and 11.2% of the patients with UP < 1.0 g/day reached ESKD. Among the patients with UP ≥1 g/gCr, the SP group showed significantly better renal outcome (p < 0.001) than the OS and NS groups. In patients with UP < 1 g/gCr, there were no differences in renal survival among the treatment groups. These trends appeared even in the CKD stage G4 patients, and were also apparent in patients taking renin-angiotensin system inhibitors. The unprecedented long-term observation period in this study may have been necessary to reveal the favorable effect of corticosteroids on ESKD progression. Conclusions In our long-term multicenter study, Corticosteroids pulse therapy was associated with better renal outcomes in IgAN patients with higher UP values, even if their eGFR values were low.http://link.springer.com/article/10.1186/s12882-018-1019-xIgA nephropathyGlomerulonephritisChronic kidney diseaseCorticosteroids pulse therapy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ryoya Tsunoda Joichi Usui Junichi Hoshino Takayuki Fujii Satoshi Suzuki Kenmei Takaichi Yoshifumi Ubara Kunihiro Yamagata |
spellingShingle |
Ryoya Tsunoda Joichi Usui Junichi Hoshino Takayuki Fujii Satoshi Suzuki Kenmei Takaichi Yoshifumi Ubara Kunihiro Yamagata Corticosteroids pulse therapy and oral corticosteroids therapy for IgA nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort study BMC Nephrology IgA nephropathy Glomerulonephritis Chronic kidney disease Corticosteroids pulse therapy |
author_facet |
Ryoya Tsunoda Joichi Usui Junichi Hoshino Takayuki Fujii Satoshi Suzuki Kenmei Takaichi Yoshifumi Ubara Kunihiro Yamagata |
author_sort |
Ryoya Tsunoda |
title |
Corticosteroids pulse therapy and oral corticosteroids therapy for IgA nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort study |
title_short |
Corticosteroids pulse therapy and oral corticosteroids therapy for IgA nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort study |
title_full |
Corticosteroids pulse therapy and oral corticosteroids therapy for IgA nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort study |
title_fullStr |
Corticosteroids pulse therapy and oral corticosteroids therapy for IgA nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort study |
title_full_unstemmed |
Corticosteroids pulse therapy and oral corticosteroids therapy for IgA nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort study |
title_sort |
corticosteroids pulse therapy and oral corticosteroids therapy for iga nephropathy patients with advanced chronic kidney disease: results of a multicenter, large-scale, long-term observational cohort study |
publisher |
BMC |
series |
BMC Nephrology |
issn |
1471-2369 |
publishDate |
2018-09-01 |
description |
Abstract Background Corticosteroids are widely used to reduce the urine protein levels of patients with immunoglobulin A nephropathy (IgAN). However, their potential preventive effects on end-stage kidney disease (ESKD) are unclear. Methods We previously performed a large-scale, long-term multicenter cohort study of patients with biopsy-proven IgAN treated between 1981 and 2013 (n = 1923). Based on the results, we reported that corticosteroids pulse therapy was potentially effective for the treatment of patients with an eGFR ≥30 ml/min/1.73m2 and a urine protein amount of ≥1 g/gCr. In the present study, we extracted 766 patients with chronic kidney disease (CKD), stage G3–G4 (15 ≤ estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73m2) from the same cohort. We divided these patients into a steroid pulse (SP) group, oral steroid (OS) group, and no steroid (NS) group, and analyzed the risk of end-stage kidney disease (ESKD) stratified by eGFR and urine protein (UP) amounts. Results Over the median long-term follow-up of 70 ± 115 months, 37.1% of the patients with UP ≥1.0 g/day and 11.2% of the patients with UP < 1.0 g/day reached ESKD. Among the patients with UP ≥1 g/gCr, the SP group showed significantly better renal outcome (p < 0.001) than the OS and NS groups. In patients with UP < 1 g/gCr, there were no differences in renal survival among the treatment groups. These trends appeared even in the CKD stage G4 patients, and were also apparent in patients taking renin-angiotensin system inhibitors. The unprecedented long-term observation period in this study may have been necessary to reveal the favorable effect of corticosteroids on ESKD progression. Conclusions In our long-term multicenter study, Corticosteroids pulse therapy was associated with better renal outcomes in IgAN patients with higher UP values, even if their eGFR values were low. |
topic |
IgA nephropathy Glomerulonephritis Chronic kidney disease Corticosteroids pulse therapy |
url |
http://link.springer.com/article/10.1186/s12882-018-1019-x |
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