Evaluating the Potential Role of Corticosteroids in Post-Infectious Glomerulonephritis

Corticosteroids are commonly used in severe post-infectious glomerulonephritis (PIGN), but the optimal dosing and long-term outcomes remain unclear. This study investigated the association between cumulative corticosteroid dosage and mortality in patients with biopsy-proven PIGN.

This retrospective cohort study included adult patients (≥18 years) with biopsy-proven PIGN from the King Chulalongkorn Memorial Hospital registry (1996-2023), excluding those with concurrent infections or conditions affecting prognosis. Clinical and histopathological data were collected. The primary outcome was kidney failure (estimated glomerular filtration rate of <15 mL/min/1.73 m² or long-term kidney replacement therapy). Time-to-event analysis compared outcomes between steroid-treated and untreated patients. Univariable logistic regression and multivariable Cox models identified mortality predictors. Receiver operating characteristic curves identified the optimal cumulative prednisolone dosage, and Kaplan-Meier analysis compared survival between steroid dosage groups.

Among 7,005 kidney biopsies, 73 patients with PIGN were analyzed. Over a median follow-up of 15.6 years, 15% died and 15% developed kidney failure. Steroids were used in 62% of patients and were associated with higher rate of skin/soft tissue infections (26% vs. 11%, p = 0.03). Despite similar baseline characteristics, multivariable Cox regression showed that steroid use was independently associated with lower mortality (HR 0.08, 95% CI: 0.01-0.61, p = 0.02). Kaplan-Meier analysis demonstrated significantly lower overall survival in patients receiving cumulative prednisolone ≥73 mg/kg or no steroids, with the best survival observed in those receiving <73 mg/kg (log-rank test, p = 0.02). Steroid-related adverse events included cushingoid appearance (11%) and osteopenia (4%).

Corticosteroids improve survival in PIGN, but cumulative doses ≥73 mg/kg increase mortality risk. Low-dose corticosteroids may be beneficial in severe PIGN, but further research is needed to refine dosing strategies.