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August 1, 2017

Corticosteroids for IgA Nephropathy: TESTING for Benefit, Discovering Harm

Author Affiliations
  • 1Glomerular Disease Center, Stanford University School of Medicine, Palo Alto, California
JAMA. 2017;318(5):429-431. doi:10.1001/jama.2017.9359

IgA nephropathy is the most common primary glomerular disease worldwide.1,2 In the United States, IgA nephropathy is second only to focal segmental glomerulosclerosis among primary glomerular diseases resulting in end-stage renal disease (ESRD), accounting for 13 012 new ESRD cases between 1996 and 2011.3 The clinical presentation is highly variable, ranging from synpharyngitic hematuria (ie, beginning within days of an upper respiratory tract infection), to asymptomatic microhematuria with or without proteinuria, to nephrotic syndrome, to rapidly progressive glomerulonephritis. However, ultimately more than one-third of patients with a biopsy-proven diagnosis of IgA nephropathy will progress to ESRD within 20 years,4,5 with attendant substantial morbidity, mortality, and health care utilization.6 Risk factors for progression to ESRD include uncontrolled hypertension, proteinuria in excess of 1 g/d, and an elevated serum creatinine level, with the presence of 1 of more of these factors a rationale for treatment initiation or patient inclusion in clinical trials.7