Retrospective Analysis of Glucocorticoid Therapy in Pediatric immunoglobulin A Nephropathy: Kidney Outcomes and Efficacy

Background : The efficacy of glucocorticoid (GC) in the management of immunoglobulin A nephropathy (IgAN) remains highly controversial. The study was conducted to analyze the efficacy and kidney outcomes of GC in the treatment of pediatric IgAN. Methods: Using the follow-up data of children with chronic kidney disease from the Department of Pediatrics at Jinling Hospital between January 2000 and December 2020, we selected children with primary IgAN who were ≤18 years old, confirmed by renal biopsy, and had undergone regular follow-up for more than 2 years. Patients who had previously used other immunosuppressive agents or had not received renin-angiotensin system blocker (RASB) treatment were excluded. The selected patients were divided into two groups based on their prior treatment regimens: the GC+RASB group and the RASB group. The primary outcome was a composite of a 40% decrease in estimated glomerular filtration rate (eGFR) from baseline, kidney failure, or death due to kidney disease. Results: A total of 374 patients (149 females) were enrolled, with 230 in the GC+RASB group and 144 in the RASB group. At baseline, the GC+RASB group had lower albumin and higher creatinine levels (all P < 0.05). From 6 months of treatment, the GC+RASB group showed higher urinary protein remission rates ( P < 0.05), but hematuria relief was similar between groups. Adverse events, including centripetal obesity, were more frequent in the GC+RASB group ( P = 0.001). After a median follow-up of 130.97 months, the GC+RASB group had fewer endpoint events (5.22% vs. 11.11%, P = 0.035) and higher cumulative kidney survival rates, particularly in patients with eGFR >50 ml/min/1.73m² and 24h-UP ≥1 g/d (all P < 0.05). Conclusions: GC therapy reduced the risk of progression to kidney failure in children with initial eGFR >50 ml/min/1.73 m² and proteinuria ≥1 g/d. No additional kidney survival benefit was observed in children with eGFR ≤50 ml/min/1.73 m² or proteinuria <1 g/d.