Corticosteroids for IgA Nephropathy: Renoprotective but Associated with Serious Harms

Corticosteroids and other immunosuppressive agents are used to treat selected patients with progressive immunoglobulin A (IgA) nephropathy, but study results have been mixed. In this randomized trial, 262 adults (mean age, 39) with IgA nephropathy received oral methylprednisolone (0.6–0.8 mg/kg daily; maximum, 48 mg daily) or placebo for 2 months, followed by tapering for 4 to 6 months. Participants were included if estimated glomerular filtration rate (eGFR) was 20 to 120 mL/minute/1.73 m² and if proteinuria was greater than 1 g daily after treatment with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers.

The trial was stopped after a median 25 months because of excess serious adverse events in the steroid group: 28 …