| Objective:To establishthe efficacy and safety of corticosteroids in the treatment of IgA nephropathy with moderate proteinuria by propensity score matching method.Methods:A retrospective study was conducted,patients with biopsy-proven IgAN in the Nephrology Department of Panzhihua Central Hospital from May 2012 to June 2021 were enrolled,who met the criteria of proteinuria 1.0-3.5g/d,eGFR≥ 30ml/min/1.73m2.Patients were divided into two groups according to treatment strategies:not-receiving corticosteroids(CS)and other immunosuppressants(the control group,group C),receiving CS but not immunosuppressants(the treatment group,group T).Propensity score matching(PSM)was employed to match two groups by age,sex,systolic blood pressure,diastolic blood pressure,24-hour urinary protein and estimated glomerular filtration rate(eGFR).The number of matching pairs determined the study sample size.The composite renal endpoints were defined as a decrease of more than 30%in eGFR from the baseline or end-stage renal disease(ESRD).Responses to therapy were devided into complete remission(CR),partial remission(PR),no response(NR).The serum creatinine,24-hour urine protein,eGFR,drug use,adverse events et al.were recorded during follow-up.The urinary protein,eGFR,responses to therapy and adverse events were compared between the two groups.Kaplan-Meier survival analysis was apllied to compare the renal survival and multiple cox regression to analyze the risk factors of composite renal endpoints.Results:A total of 154 patients met the inclusion and exclusion criterias,of which 33 patients using immunosuppressants were excluded.There were 61 patients in group T and 60 patients in group C.After propensity score matching,102 patients were included in the analysis,51 cases in each group.All patients were treated with maximum tolerated dose of renin-angiotensin system inhibitors(RASI).The main type of used corticosteroids in the treatment group was prednisone(92.2%).Except for the level of serum IgA,there was no significant difference in baseline clinical and renal pathological indexes between the two groups.The average follow-up time was 31.0±21.9 months.At the end of follow-up,the level of proteinuria in the treatment group was significantly lower than that in the control group(0.3[0.1,0.5]vs.0.5[0.2,1.0]g/d,P<0.05).Compared with the control group,the remission rate(CR+PR)(68.6%vs.47.1%,P<0.05)and the kidney survival rate(21.6%vs.9.6%,P<0.05)of the treatment group was significantly higher.COX multivariate regression showed that not treated with CS(OR=4.3[95%CI,1.34-13.9];P=0.013)and microscopic hematuria(OR=4.8[95%CI,1.5-14.9];P=0.007)were risk factors for composite renal endpoints.Two patients(3.9%)in the control group while none in the treatment group progressed to ESRD.There were no significant differences in the incidences of both serious adverse events(SAE)and adverse events(AE)between the two groups.Conlusion:Compared with supportive therapy,corticosteroids in IgA nephropathy with moderate proteinuria can effectively reduce proteinuria and improve renal prognosis without significantly increasing adverse reactions,suggesting the beneficial effects of corticosteroids on IgAN patients with moderate proteinuria. |
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