Role of corticosteroid therapy in IgA nephropathy; where do we stand? www.nephropathol.com DOI: 10.15171/jnp.2017.61 J Nephropathol. 2017;6(4):368-373 Journal of Nephropathology *Corresponding author: Shankar Prasad Nagaraju, Email: shankarmmcmed@yahoo.com Shankar Prasad Nagaraju 1* , Sindhura Lakshmi Koulmane Laxminarayana 2 , Aswani Srinivas Mareddy 3 , Srikanth Prasad 1 , Sindhu Kaza 1 , Srinivas Shenoy 1 , Karan Saraf 1 , Dharshan Rangaswamy 1 , Ravindra Prabhu Attur 1 , Rajeevalochana Parthasarathy 4 , Uday Venkat Mateti 5 , Vasudeva Guddattu 6 , Mahesha Vankalakunti 7 1 Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, India 2 Department of Pathology, Kasturba Medical College, Manipal University, Manipal, India 3 Department of Nephrology, Guntur Hospital, Guntur, India 4 Department of Nephrology, Madras Medical Mission, Chennai, India 5 Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte University, Mangalore, India 6 Department of Statistics, Kasturba Medical College, Manipal University, Manipal, India 7 Department of Pathology, Manipal Hospital, Bangalore, India Original Article ARTICLE INFO Article type: Original Article Article history: Received: 17 January 2017 Accepted: 5 May 2017 Published online: 28 May 2017 DOI: 10.15171/jnp.2017.61 Keywords: IgA Nephropathy eGFR Corticosteroids Immunosuppression Proteinuria Background: Current KDIGO guidelines suggest corticosteroids (CS) administration in IgA nephropathy (IgAN) with persistent proteinuria >1 g/d despite 3-6 months of supportive care and estimated glomerular filtration rate (eGFR) >50 mL/min/1.73 m 2 . The benefits of CS in patients with eGFR <50 mL/min/1.73 m 2 is unclear. Objectives: To assess the effect of steroids on disease progression and proteinuria in IgAN patients with eGFR < 50 mL/min/ 1.73m 2 compared with >50 mL/min/1.73 m 2 . Patients and Methods: A cohort of biopsy proven primary IgAN diagnosed between March 2010 - February 2015 who received oral CS with minimum follow-up of 6 months were included. They were categorized into two groups according to their eGFR (group 1 - eGFR <50 mL/min/1.73 m 2 , group 2 - eGFR >50 mL/min/1.73 m 2 ). The eGFR and urine protein creatinine ratio (UPCR) were followed up at entry, 6 months, 12 months and at the end of follow-up. Outcomes studied were change in eGFR, proteinuria and progression to end-stage renal disease (ESRD). Results: Out of 44 patients, 23 were in group1 and 21 patients in group 2. At the end of follow-up, similar reduction of proteinuria (UPCR) was observed in both groups (P = 0.62). However, group 1 had a significant fall in eGFR compared to improvement in group 2 (P = 0.004). One in each group has reached CKD stage 5 (P = 0.73). Conclusions: Addition of CS to conservative treatment in IgAN patients with initial eGFR<50 ml/min/1.73 m 2 seems to reduce proteinuria but not beneficial in preventing progression of disease as compared to patients with higher eGFR (>50 mL/min/1.73 m 2 ). ABSTRACT Implication for health policy/practice/research/medical education: The benefit of using steroids in subgroup of IgA nephropathy patients with eGFR<50 ml/min/1.73 m 2 is unclear. In this retrospective study we compared the effect of steroids on disease progression and proteinuria in IgAN patients with eGFR < 50 mL/min/1.73 m 2 (group 1) to those with >50 mL/min/1.73 m 2 (group 2). Out of 44 patients, 23 were in group1 and 21 patients in group 2. At the end of follow-up, similar reduction of proteinuria (UPCR) was observed in both groups (P = 0.62). But there was a significant fall in eGFR in group 1, whereas group 2 showed improvement (P = 0.004). Administration of corticosteroids (CS) in addition to conservative treatment seems to reduce proteinuria but not beneficial in preventing progression of disease in IgAN patients with eGFR<50 ml/min/1.73 m 2 . Please cite this paper as: Nagaraju SP, Laxminarayana SLK, Mareddy AS, Prasad S, Kaza S, Shenoy S, et al. Role of corticosteroid therapy in IgA nephropathy; where do we stand? J Nephropathol. 2017;6(4):368-373. DOI: 10.15171/jnp.2017.61.