Treatment Of Glucocorticoid For IgA Nephropathy:A Systematic Review

Objective:The efficacy and risk of glucocorticoid(GC)for the treatment of IgA nephropathy remain uncertain.This topic through the systematic evaluation of pure GC on IgA nephropathy(IgAN)nephropathy efficacy and safety.Methods:Chinese Biomedical Database,CNKI,VIP,EMBASE,Cochrane Library,PubMed and MEDLINE were searched and collected randomized controlled trial(RCT)of simple glucocorticoid on IgAN the FromJanuary 1966 to December 2017.Two reviewers independently evaluated the quality of the study and extracted data.Revman 5.3 software was used for data analysis.The results of statistical analyses were expressed as relative risk(Relative risk,RR)or standardized mean difference(Standard Mean Difference,SMD),with 95%confidence intervals(CI).Results:A total of 11 articles were included,including 952 cases(steroid group 483 patients,control group 469 patients).Meta-analysis showed that:1.GC can effectively reduce proteinuria in patients with IgAN and reduce the risk of ESRD;2.Different doses of GC have a good effect for IgAN patients with proteinuria,but small Dose of GC can not reduce the risk of the ESRD;3.Different courses(?1 year?<1 year)of GC improved IgAN patients with proteinuria,and only a short course of GC can reduce the risk of ESRD;4.Whether IgAN patients'GFR upper or lower than50ml/min/1.73m~2,GC can reduce proteinuria and risk of ESRD.5.GC significantly increased serious Infection,abnormal blood glucose,gastrointestinal reactions and weight gain.Conclution:1.GC treatment of IgA nephropathy proteinuria has a good effect,and can effectively reduce the risk of the ESRD;2.Whether prednisone>30mg/d(methylprednisolone>24mg/d)or prednisone?30mg/d(methylprednisolone?24mg/d)can reduce the proteinuria of IgA nephropathy,only high-dose GC can effectively reduce the risk of ESRD;3.The total course of GC treatment is better for 6 to 12 months;4.GC can still be used in patients with IgA nephropathy GFR<50ml/min/1.73m~2;5.The treatment of GC need monitoring of adverse reactions.GC provides kidney protection in patients with IgA nephropathy,but increases the risk of adverse events.The efficacy and safety of GC for IgA nephropathy require large,high-quality samples,and a multicenter randomized controlled study further confirms.