When Should You Start Steroid Treatment with IgA Nephropathy
When should you start steroid treatment with IgA Nephropathy? To choose the best time for treatment will help you get well quickly. Now go on reading to learn more information.
Glomerulonephritis is the leading cause of uremia. The most common form of glomerulonephritis is IgA nephropathy, which accounts for 40 to 50 percent of chronic glomerulonephritis.
Currently there is no specific drug for IgA nephropathy on the market. When proteinuria is high, we still tend to use glucocorticoid and other immunosuppressive therapy.
Glucocorticoid, or prednisone, methylprednisolone, cortisone, dexamethasone and other steroid drugs, has been a mainstay in the treatment of Chronic Kidney Disease since the 1950s. However, due to the high side effects of steroids, we generally only use them in patients with high urinary protein and high risk of renal failure.
Can you use steroids when proteinuria is 1g?
In the past, the consensus among nephrologists was that glucocorticoid therapy should be initiated if the 24-hour urinary protein level of IgA nephropathy patients reached 1 g. Nephrologists used to follow these guidelines.
What is the concept of "1 gram" of urinary protein? It can be regarded as the dividing line of whether the renal function of patients with IgA nephropathy will be obviously impaired.
However, clinical studies in recent years have found that steroid administration at 1g/24h of urinary protein may not benefit patients with IgA nephropathy.
On May 22, 2016, at the annual meeting of European nephropathy held in Vienna, Austria, the nephrology expert team of Peking University hospital in China reported the analysis results of the "global study on the evaluation of glucocorticoid therapy for IgA nephropathy".
Since 2012, the trial has included 500 patients with IgA nephropathy taking steroids from 70 hospitals around the world, making it the largest international clinical trial in the field.
The patients were divided into two groups: one was treated with methylprednisolone and the other with blood pressure medication.
The results showed that glucocorticoid (methylprednisolone) treatment for IgA nephropathy, the world's most common glomerulonephritis, reduced the incidence of renal failure by two-thirds but significantly increased the incidence of serious adverse events, including fatal infections. When the amount of 24-hour urine protein is about 1g, the risks are more likely to outweigh the benefits.
This study is expected to change the current international guidelines for clinical practice of glomerulonephritis.
Treatment of IgA nephropathy
Most IgA nephropathy is not too sensitive to steroids, and patients with more urinary protein often fail to achieve clinical cure after using steroids (urinary protein 0.5g/24h).
1. Patients with urinary protein 0.5-1g are recommended to be treated with ACEI/ARBs, along with antiplatelet and anticoagulant therapy. If proteinuria can not be reduced to less than 0.5 g, Chinese medicine can be considered.
2. Patients whose urine protein is still above 1g/24 hours after using ACEI/ARBs are recommended to be treated with Chinese Medicine Treatments after dialectical differentiation. ACEI/ARBs with Chinese medicine can bring the urine protein down to 1 g.
3. Whether to use steroids in IgA nephropathy patients with 1-2 grams of urinary protein requires comprehensive consideration. If the pathologic report shows cellular crescent-formation, it is an indication for the use of steroids. At present, many patients with IgA nephropathy who are taking steroids do not need steroids actually.
The current problem is that steroids and Chinese medicines are used too much and not standardized, while the treatment based on syndrome differentiation of ACEI/ARBs and traditional Chinese medicine is neglected. In general, ACEI/ARBs should be the first choice for IgA nephropathy. When proteinuria is too much, Chinese medicine can be used together. And the final treatment is steroids and other immunosuppressants. For more information on IgA Nephropathy treatment, please leave a message below or contact online doctor.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***