Enteric Budesonide in Transplant and Native IgA Nephropathy: Real-World Clinical Practice

Over 30% of patients with immunoglobulin A Nephropathy (IgAN) progress to end stage Chronic Kidney Disease and once they are transplanted, up to 50% suffer IgAN recurrence. Based on the gut-kidney axis, targeted-release-formulation budesonide (TRF-budesonide) has proved proteinuria reduction and estimated glomerular filtration rate (eGFR) benefit. We retrospectively assessed 14 patients with IgAN (5 kidney transplants and 9 native kidneys) treated with a median dose of 9mg/day of TRF-budesonide between December 2017 and January 2022 in our Nephrology department. Mean age of 46±17.21 years. All kidney transplants and 6/9 (66.7%) patients with native kidneys were already receiving renin-angiotensin system (RAS) inhibitors. The relative decrease of proteinuria was of -33.1% and -54.6% after 3 and 6 months of TRF-budesonide treatment (p<0.05 and p<0.05, respectively). If kidney transplant were evaluated separately, proteinuria did also significantly decrease (-26.7%) after 3 months of treatment (p<0.05). CKD-EPI, serum creatinine and haematuria were not modified. No clinical relevant adverse events were observed throughout the follow-up. TRF-budesonide significantly reduced proteinuria, maintained eGFR levels and was well tolerated during 24 months of follow-up in patients with IgAN. Therefore, TRF-budesonide may represent a new approach to IgAN treatment in both patients with native and kidney transplant.