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The outcomes of adults with sporadic post-infectious glomerulonephritis (PIGN) are generally poor. The value of glucocorticoid treatment was analyzed in the largest biopsy registry with a long-term follow-up period.
Participants with sporadic biopsy-proven post-infectious glomerulonephritis (PIGN) and availability of both baseline and ≥2 subsequent serum creatinine measurements after the kidney biopsy were included from the King Chulalongkorn Memorial Hospital (KCMH) kidney biopsy registry covering the period from 1996 to 2023. Patient survival and the impact of glucocorticoid treatment on mortality were analyzed as time-to-event outcomes using the Kaplan-Meier method with the Log-rank test and a multivariable Cox proportional hazards model. Adjustments were made for various covariates. All statistical analyses were conducted using STATA version 15 for MAC software (StataCorp, College Station, Texas).
Among 7005 kidney biopsies, 86 participants were selected. Death occurred in 11 participants (13%) during a median follow-up period of 15.6 (IQR 8.2-19.3) years. The median age was 41 (IQR 28-57) years, with a female predominance (57%) and 14% having diabetes. Baseline serum creatine and urine protein-creatinine ratio were 2.0 (IQR 1.1-3.5) mg/dL and 3.8 (IQR 1.8-7.4) g/gCr, respectively. In univariable analysis, death was more prevalent in older patients with a higher percentage of global sclerosis, positive IgA and fibrinogen staining, and those free of immunosuppressive agent. Using the Log-rank test, glucocorticoid treatment at a dosage <73 mg/kg was significantly associated with the longest time to death (Figure 1). Of note, the side effect of immunosuppression did not show a significant difference.
Glucocorticoid treatment at an appropriate dosage demonstrated benefits for selected cases of PIGN patients, underscoring the need for further investigation.