Nefropatía por IgA. ¿Son los esteroides intravenosos más eficaces que los esteroides orales en la prevención de recaídas?

Translated title of the contribution: IGA nephropathy – Are intravenous steroid pulses more effective than oral steroids in relapse prevention?

Ivo Laranjinha, Patrícia Matias, João Cassis, Patrícia Branco, Sância Ramos, José Diogo Barata, André Weigert

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Abstract

Introduction: It is recommended that IgA nephropathy (IgAN) is treated with steroids when the glomerular filtration rate (GFR) is >50 ml/min and proteinuria >1 g/day. Few studies have been performed comparing the two accepted steroid regimens (1 g/day methylprednisolone pulses for 3 consecutive days at the beginning of months 1, 3 and 5, followed by 0.5 mg/kg prednisolone on alternate days vs. 1 mg/kg/day oral prednisolone). The aim of this study was to compare these two steroid regimens in IgAN treatment. Methods: We selected 39 patients with biopsy-proven IgAN treated with steroids. Mean age at diagnosis was 37.5 years, 23 males (59%), baseline proteinuria (Uprot) was 2.1 g/day and median serum creatinine (SCr) was 1.5 mg/dl. The mean follow-up period was 56 months. Twenty-five patients (64%) were treated with methylprednisolone pulses and 14 (36%) with oral steroids. Results: Patients treated with steroid pulses presented lower relapse risk, defined as the reappearance of Uprot >1 g/day and an Uprot increase of more than 50% (incidence rate ratio of 0.18, 95% CI 0.02–0.5). The Kaplan–Meier analysis showed longer relapse-free period (p = 0.019). This result was confirmed in a multivariate analysis (p = 0.026). However, we did not find other differences between the two steroid regimens. Conclusions: In comparison to oral steroids, the intravenous pulse regimen was associated with a lower risk of relapse in IgAN, a known independent negative predictor of renal survival. No differences were found regarding the other renal outcomes.

Translated title of the contributionIGA nephropathy – Are intravenous steroid pulses more effective than oral steroids in relapse prevention?
Original languageSpanish
Pages (from-to)427-432
Number of pages6
JournalNefrologia
Volume38
Issue number4
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • Esquemas de esteroides
  • IgA nephropathy
  • Nefropatía por IgA
  • Renal survival
  • Steroid regimens
  • Supervivencia renal

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