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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 4  |  Page : 804-805
Corticosteroids in IgA nephropathy: Daily oral or intravenous pulses followed by every other day oral administration


1 Center for Nephrology "G. Papadakis", General Hospital of Nikea, Pireaus, Greece
2 Department of Nephrology, University Hospital of Patras, Greece

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Date of Web Publication8-Jul-2015
 

How to cite this article:
Ioanna R, Pantelitsa K, Sinodi Z, Miltiades G, Dimitrios G, Christos I. Corticosteroids in IgA nephropathy: Daily oral or intravenous pulses followed by every other day oral administration. Saudi J Kidney Dis Transpl 2015;26:804-5

How to cite this URL:
Ioanna R, Pantelitsa K, Sinodi Z, Miltiades G, Dimitrios G, Christos I. Corticosteroids in IgA nephropathy: Daily oral or intravenous pulses followed by every other day oral administration. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2022 Jan 26];26:804-5. Available from: https://www.sjkdt.org/text.asp?2015/26/4/804/160223
To the Editor,

IgA nephropathy (IgAN) is the most common primary glomerulonephritis with variable frequency in different regions throughout the world. [1],[2],[3] Clinical presentation ranges from asymptomatic hematuria to rapidly progressive glomerulonephritis. [4] Most commonly, patients present with macroscopic hematuria or microscopic hematuria and/or mild proteinuria. Nephrotic-range proteinuria is uncommon and can be seen at different stages of disease. About 30% of patients with IgAN are at risk to reach endstage renal disease (ESRD) after 10 years of progression of the disease. [5]

In patients with active and progressive IgAN (hematuria, proteinuria >1 g/day, increasing serum creatinine), the use of corticosteroids is associated with a decrease of urinary protein excretion and lower risk of progression to ESRD. [6],[7],[8],[9]

In clinical practice, steroids have been tried in patients with IgAN on a daily or alternate day administration with variable results. However, there is no consensus for the optimal therapeutic schedule. To assess the efficacy of daily oral administration of corticosteroids versus the use of intravenous pulses followed by every other day oral administration, we retrospectively studied 16 adult patients with biopsyproven IgAN treated by corticosteroids. The criteria for administration of corticosteroids were proteinuria >0.5 g/24-h and wellpreserved renal function (serum creatinine <1.5 mg/dL). Patients with secondary forms of IgAN related to other systemic diseases, those with urinary protein <0.5 g/24 h and those with contraindication to corticosteroid administration were excluded from the study.

Two regimens of corticosteroids were used: Eight patients (group A) received oral prednisone at a dose of 1 mg/kg of body weight (BW) initially, followed by gradual tapering of the dose for a total period of 12 months and eight patients (group B) received 1 g of methylprednisolone intravenously for three consecutive days at the beginning of every other month (months 1, 3 and 5) plus oral prednisone at a dose 0.5 mg/kg BW every other day for six months. [9]

The mean age of the patients was 39 ± 11 years. All the patients received treatment with angiotensin-converting-enzyme (ACE) inhibitors. At diagnosis, most patients from group A had levels of proteinuria between 1 and 3 g/day, whereas the majority of patients from group B had nephritic-level proteinuria (>3 g/day). After completion of treatment with corticosteroids, no significant differences in the presence of hematuria (P = 0.07), mean serum creatinine (P = 0.45) and level of proteinuria (P = 0.21) were observed between the two groups of patients. Proteinuria reduced to below 1 g/day in four patients (50%) from group A and in five patients (62.5%) from group B. The mean serum creatinine remained unchanged in both groups (P = 0.45). When protein excretion was considered as a continuous variable, the median levels of proteinuria decreased significantly from 1.6 g/24-h to 0.3 g/24-h (P = 0.01) in patients of group A and from 5.3 mg/24-h to 0.7 mg/24-h (P = 0.02) in patients of group B. During the administration of corticosteroids, no side-effects were observed in any patient from either group.

Daily oral prednisolone has been tested in IgAN patients, and it succeeded in inducing remission of proteinuria and preservation of renal function. [9] Pozzi et al [7] first used pulse intravenous methylprednisolone followed by oral administration of prednisone on alternate day for six months and showed in a prospective randomized trial that kidney survival was significantly better in the steroid-treated patients in comparison with the placebo-treated patients. Moreover, extending their observations to 10 years, [8] the same authors found that this steroid regimen seemed to be safe and effective during the long-term follow-up.

In our study, we compared the two different steroid protocols commonly used in the clinical practice [daily oral versus intravenous (IV) pulse followed by every other day oral] in IgAN patients. Both schedules seemed to provide equal safety and efficiency in reducing proteinuria levels and stabilizing renal function. Considering that the group treated with the every other day regimen had worse baseline clinical features, IV pulse treatment followed by oral alternate day administration of cortico steroids seems to be the more effective regimen in comparison with only every day oral administration of corticosteroids. Further research with a randomized controlled trial is required in order to confirm this observation.

Conflict of interest: None declared.

 
   References Top

1.
D'Amico G. Influence of clinical and histological features on actuarial renal survival in adult patients with idiopathic IgA nephropathy, membranous nephropathy, and membranoproliferative glomerulonephritis: Survey of the recent literature. Am J Kidney Dis 1992;20:315-23.  Back to cited text no. 1
    
2.
Donadio JV, Grande JP. IgA nephropathy. N Engl J Med 2002;347:738-48.  Back to cited text no. 2
    
3.
Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China: Analysis based on 13,519 renal biopsies. Kidney Int 2004;66:920-3.  Back to cited text no. 3
    
4.
D'Amico G. Natural history of idiopathic IgA nephropathy: Role of clinical and histological prognostic factors. Am J Kidney Dis 2000;36: 227-37.  Back to cited text no. 4
    
5.
Simon P, Ramee MP, Boulahrouz R, et al. Epidemiologic data of primary glomerular diseases in western France. Kidney Int 2004;66:905-8.  Back to cited text no. 5
    
6.
Kobayashi Y, Hiki Y, Kokubo T, Horii A, Tateno S. Steroid therapy during the early stage of progressive IgA nephropathy. A 10-year follow-up study. Nephron 1996;72:237-42.  Back to cited text no. 6
    
7.
Pozzi C, Bolasco PG, Fogazzi GB, et al. Corticosteroids in IgA nephropathy: A randomised controlled trial. Lancet 1999;353:883-7.  Back to cited text no. 7
    
8.
Pozzi C, Andrulli S, Del Vecchio L, et al. Corticosteroid effectiveness in IgA nephropathy: Long-term results of a randomized, controlled trial. J Am Soc Nephrol 2004;15:157-63.  Back to cited text no. 8
    
9.
Waldo FB, Alexander R, Wyatt RJ, Kohaut EC. Alternate-day prednisone therapy in children with IgA-associated nephritis. Am J Kidney Dis 1989;13:55-60.  Back to cited text no. 9
    

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Correspondence Address:
Dr. Revela Ioanna
Center for Nephrology "G. Papadakis", General Hospital of Nikea, Pireaus
Greece
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DOI: 10.4103/1319-2442.160223

PMID: 26178564

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