Corticosteroids in IgA nephropathy: a randomised controlled trial

Background IgA nephropathy is progressive in most cases and has no established therapy. In this randomised trial, we assessed the efficacy and safety of a 6-month course of steroids in this disorder. Methods Between July, 1987, and September, 1995, we enrolled 86 consecutive patients from seven renal units in Italy. Eligible patients had biopsy-proven IgA nephropathy, urine protein excretion of 1·0–3·5 g daily, and plasma creatinine concentrations of 133 μmol/L (1·5 mg/dL) or less. Patients were randomly assigned either supportive therapy alone or steroid treatment (intravenous methylprednisolone 1 g per day for 3 consecutive days at the beginning of months 1, 3, and 5, plus oral prednisone 0·5 mg/kg on alternate days for 6 months). The primary endpoint was deterioration in renal function defined as a 50% or 100% increase in plasma creatinine concentration from baseline. Analyses were by intention to treat. Findings Nine of 43 patients in the steroid group and 14 of 43 in the control group reached the primary endpoint (a 50% increase in plasma creatinine) by year 5 of follow-up (p<0·048). Factors influencing renal survival were vascular sclerosis (relative risk for 1-point increase in score 1·53, p=0·0347), female sex (0·22, p=0·0163), and steroid therapy (0·41, p=0·0439). All 43 patients assigned steroids completed the treatment without experiencing any important side-effects. Interpretation A 6-month course of steroid treatment protected against deterioration in renal function in IgA nephropathy with no notable adverse effects during followup. An increase in urinary protein excretion could be a marker indicating the need for a second course of steroid therapy.