Should we really STOP treating patients with IgA nephropathy with steroids?

Area of Science:

• Nephrology
• Immunology
• Internal Medicine

Background:

• IgA nephropathy (IgAN) is a prevalent glomerular disease worldwide.
• Historically viewed as benign, IgAN is now recognized as a potential cause of end-stage kidney disease (ESKD).
• Steroid therapy has been investigated for IgAN since the 1980s.

Purpose of the Study:

• To evaluate the efficacy and safety of steroid therapy in IgA nephropathy.
• To address recent controversies regarding steroid treatment in IgAN.

Main Methods:

• Review of uncontrolled and controlled studies on steroid therapy for IgAN.
• Analysis of data on proteinuria reduction and ESKD risk.
• Consideration of safety and tolerability profiles.

Main Results:

• The majority of studies indicate that steroids reduce proteinuria and the risk of ESKD in IgAN patients.
• Benefits are observed with reasonable safety and tolerability, particularly at low doses for ≤6 months.
• Recent randomized controlled trials have challenged these findings, but possess significant limitations.

Conclusions:

• Steroid therapy remains a beneficial treatment option for IgAN, offering reduced proteinuria and delayed ESKD.
• The established benefits should be weighed against recent trial data, considering the methodological drawbacks of the latter.
• Careful patient selection and treatment protocols are crucial for optimizing steroid therapy outcomes in IgAN.