GLUCOCORTICOID TOXICITY INDEX IN MEMBRANOUS NEPHROPATHY AND PODOCYTOPATHIES IN ADULT: A PILOT STUDY

Introduction:

Glucocorticoids (GCs) are frequently employed in managing nephrotic syndrome, including conditions such as focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD), and primary membranous nephropathy (PMN). However, their therapeutic use is often limited by significant toxicities. This study assesses the Glucocorticoid Toxicity Index (GTI) in adults diagnosed with these podocytopathies and investigates the correlation between GTI and cumulative GC doses.

Methods:

This prospective observational study included 45 patients with newly diagnosed, biopsy-confirmed MCD, FSGS, and PMN, all initiated on standard GC-based therapy. Participants were monitored over a 12-month period from January 2023 to June 2024. Baseline assessments comprised BMI, HbA1c, blood pressure, bone mineral density (via DEXA scan), lipid profile, clinical musculoskeletal examination, dermatological and neuropsychiatric evaluations, and ophthalmological assessments. The GTI was calculated at baseline, 3 months, 6 months, and 12 months. Data were analysed using appropriate statistical tests to compare GTI scores and cumulative GC doses.

Results:

Among the 45 patients, 32 (71.1%) were male, with a mean age of 37.31 ± 14.36 years. The cohort included 10 cases of FSGS, 22 cases of MCD, and 13 cases of PMN. Initially, 90.9% had a BMI of <27 kg/m², 97.7% had normal HbA1c levels, and all were normotensive. Follow-up revealed significant increases in BMI, glucose intolerance, and dyslipidaemia. Observations also included bone density loss and mild skin and neuropsychiatric toxicity. At 3 months, mean GTI scores differed significantly (P = 0.024): FSGS (50.78 ± 17.08), MCD (44.94 ± 27.57), and PMN (23.75 ± 21.21). Gastrointestinal side effects were prevalent (35.5%). At 6 months, lumbar spine BMD decreased to 0.86 (P = 0.025), while hip BMD remained stable at 0.82 (P = 0.802). T-scores declined at the lumbar spine (-1.80, P = 0.018) and hip (-0.95, P = 0.002). Z-scores decreased at the lumbar spine (-1.0, P = 0.012) but were unchanged at the hip (-0.15, P = 0.601). At 12 months, lumbar spine BMD increased to 0.92 (P = 0.008), whereas hip BMD decreased to 0.77 (P = 0.001). T-scores were stable at the lumbar spine (-1.70, P = 0.002) but decreased at the hip (-1.15, P = 0.129). The Z-score at the lumbar spine was -1.05 (P = 0.012) and at the hip -0.55 (P = 0.313). A negative correlation between cumulative dose and GTI at 3 months (correlation coefficient: -0.397, P = 0.020) was observed, although this trend was inconsistent over time.

Conclusions:

This study is the first to evaluate the GTI in patients with kidney diseases, primarily FSGS, MCD, and PMN. The GTI scores at 3 months indicate a significant impact of corticosteroid therapy in individuals with primary glomerular diseases. Regular DEXA scans are essential for monitoring bone health in patients undergoing glucocorticoid therapy. These findings underscore the necessity for individualized treatment strategies to optimize patient outcomes. Further research is essential to develop long-term approaches to minimize adverse effects in this patient population.  

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.