Corticosteroid therapy in IgA nephropathy with minimal change-like lesions: a single-centre cohort study.

BACKGROUND: There is a lack of high-quality evidence that advocates the use of corticosteroids for IgA nephropathy (IgAN) with minimal change-like lesions (also called IgAN with minimal change disease, MCD-IgAN).

METHODS: Twenty-seven biopsy-proven adult MCD-IgAN patients were enrolled. Daily single dose of 1 mg/kg (maximum 60 mg/day) prednisone was given until complete remission (CR), followed by gradually decreasing dosage. The clinical data were collected from baseline up to 12 weeks of treatment (Certification No. 2011NLY-006, Clinical trials gov ID. NCT01451710).

RESULTS: The patient cohort consisted of 15 males and 12 females. The mean age of the patients was 29.2 ± 10.8 years (range 18-60 years) at the time when they were subject to renal biopsy. All patients had hypoalbuminaemia (23.7 ± 4.13 g/L) and heavy proteinuria (>3.5 g/24 h). Cumulative CR (proteinuria < 0.4 g/24 h) rates were 3.70, 48.1, 92.6 and 100% after 1, 2, 4 and 8 weeks of treatment, respectively. Two cases relapsed after CR, one at 6 weeks of treatment, likely due to failure to follow the corticosteroid withdrawal schedule, and the other one at 8 weeks of treatment accompanied with an upper respiratory infection. Infection, alanine aminotransferase elevation (>2-folds), fasting blood glucose (FBG) elevation (>6.2 mmol/L) and hypopotassaemia (<3.5 mmol/L) occurred in 2, 5, 2 and 5 cases, respectively, but were eliminated after treatment.

CONCLUSION: Corticosteroid therapy is likely effective and safe for MCD-IgAN patients.