Corticosteroids in IgA nephropathy: Lessons from recent studies

Abstract

IgA nephropathy (IgAN) is a common chronic glomerular disease that, inmost patients, slowly progresses to ESRD. The immune and autoimmune responses that characterize IgAN indicate a potential benefit for corticosteroids. The 2012 Kidney Disease ImprovingGlobalOutcome (KDIGO) guidelines suggest giving corticosteroids to patientswith rather preserved renal function (GFR.50ml/min per 1.73m2) and persistent proteinuria >1g/d, despite3-6months of optimized supportive care with renin-angiotensin system blockers. However, the evidence supporting this guideline was considered of low quality. More recent results from large cohort studies and randomized, controlled trials have provided conflicting messages about the benefits of corticosteroid treatment over supportive care alone, mostly involving optimized renin-angiotensin system blockade, which might generate further uncertainty in the therapeutic choice. Overall, these results indicate that corticosteroids are a powerful tool for treating patients with IgAN; however, treatment success is not universal andmostlyoccurs in patientswho are highly proteinuric with early CKD. In patients with advanced CKD, the side effects of corticosteroids increase, and the renal protection decreases. This brief review aimed at integrating the findings of these recently published reports to provide balanced advice for clinicians as well as suggestions for future trials.