Effect of steroid pulse therapy on post-transplant immunoglobulin A nephropathy

AimRecent studies have suggested that patients with post-transplant immunoglobulin A nephropathy have poor graft survival. There is limited research on the therapeutic effectiveness for post-transplant immunoglobulin A nephropathy, especially steroid pulse therapy. The present study evaluated the efficacy of steroid pulse therapy on post-transplant immunoglobulin A nephropathy. MethodsWe retrospectively analyzed patients diagnosed with de novo or recurrent immunoglobulin A nephropathy at Kyushu University Hospital between January 2013 and August 2015. Patients with moderate proteinuria (0.5 g/g creatinine) and/or cellular or fibrocellular crescents on a graft biopsy were treated with steroid pulse therapy. Steroid pulse therapy was 500 mg/day for 3 days in weeks 1 and 2, followed by 20 mg of oral prednisolone that was tapered after 6 months. Patients were followed for 2 years, and the estimated glomerular filtration rate, urinary findings, and adverse events were recorded. ResultsSeven patients received steroid pulse therapy. The mean duration after kidney transplantation was 6.6 4.7 years. After 2 years of treatment, 85.7% of patients reached complete remission of proteinuria, urinary protein excretion declined (0.82 0.51 to 0.26 +/- 0.22 g/g creatinine, P = 0.007), and the estimated glomerular filtration rate was maintained (48.7 +/- 12.8 to 47.4 +/- 14.0 mL/min per 1.73 m(2), P = 0.98). Adverse events were observed in one patient who developed herpes zoster infection. ConclusionSteroid pulse therapy for post-transplant immunoglobulin A nephropathy effectively reduces proteinuria over 2 years. However, comparison of steroid pulse therapy and other regimens with a high-quality design is required. SUMMARY AT A GLANCE This article presents a retrospective study in which the effect of steroid pulse therapy on post-transplant IgA nephropathy was examined.