Abstract: TH-PO1028
Clinical Response to Budesonide in Biopsy-Proven IgA Nephropathy
Session Information
- Glomerular Diseases: Minimal Change Disease, FSGS, IgAN
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Author
- Lingaraj, Umesh, Institute of Nephrourology, Bangalore, Karnataka, India
Background
Primary IgA nephropathy is the most prevalent chronic glomerular disease worldwide.
STOP-IgAN trial has questioned the benefit of systemic immunosuppression
And significant (24%) mean UPCR reduction from baseline has been concluded from NEFIGAN study.
So in this study we aimed at studying the effect of oral controlled release budesonide in biopsy proven IgA nephropathy patients.
Methods
This is a interim analysis of on going study conducted in department of Nephrology,Institute of Nephro-Urology,Bangalore,India from May 2017.
A total of 40 patients with biopsy proven IgA nephropathy were included in study.
All patients were optimised on RAS inhibitors, Omega 3 fatty acids and budesonide.
A decision to start all drugs together was considered as isolated RAS inhibitors will not prevent immunological damage by ongoing IgA deposition.
Based on histology ( MEST SCORE ) patients were started with 9mg and 12mg budesonide .
Patients with crescents were treated with oral and IV cyclophosphamide and prednisone followed by budesonide.
All patients were regularly followed up every 4 weeks to monitor vitals, Renal function test and Urine PCR.
Our primary outcome was mean change from baseline in 24 hr urine protein at the end of 3rd and 6th Month.
Clinical response was defined as complete (CR),partial (PR) or non- responders( NR) according to recent definitions.
Results
22(55%) were males and 18 (45%) were females.
Mean age was 48.27 yrs.
Mean creatinine at presentation was 3.02 gm
Mean proteinuria at presentation was 3.83 gm / 24 hours
11(40) had eGFR > 45ml/min/1.7m2 And 29(40) had eGFR < 45ml/min/1.7m2
All patients were optimised with RAS inhibitors and omega 3 fatty acids
3(7.5%) were treated with cyclophosphamide, prednisone and budesonide
3(7.5%) were treated with prednisone and budesonide.
34 (85%) were treated with budesonide.
RESPONSE:
CR-7(40)19%
PR-18(40)49%
NR-12(40) 32%
Lost follow up - 3(40)
CR and PR was higher in eGFR >45ml/min/1.7m2 (20% vs 18.5% and 50%vs 44%).
NR was higher in eGFR < 45ml/min/1.7m2. ( 37% vs 39%)
Percentage change in mean 24 HUP from baseline: 29.02%.
Mean change in Serum Creatinine from baseline: 0.9 mg/dl
Conclusion
Budesonide ,together with optimised RAS blockade, reduced proteinuria in patients with IgA nephropathy.
Our patients probably had the advantage of blocking the intestinal access of IgA dysregulation right from presentation, hence reflecting a slightly better outcome than NEFIGAN trial.
Funding
- Government Support - Non-U.S.