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IgA nephropathy (IgAN) represents the most prevalent form of glomerulonephritis, particularly in developed nations. Despite the high prevalence of this condition, treatment options remain a topic of debate. Recent years have witnessed the emergence of numerous clinical trials proposing specific treatments. In Bulgaria, patients still have limited access to novel treatments, prompting us to share our experiences with existing therapeutic modalities and advocate for enhanced knowledge and treatment evolution.
We conducted a retrospective, single-center analysis of patients with biopsy-confirmed IgAN over a decade in a tertiary Bulgarian medical institution. Our study encompassed 125 patients who underwent treatment with ACE inhibitors, angiotensin receptor blockers (ARBs), corticosteroids, cyclophosphamide, azathioprine, or combinations thereof, such as ACE/corticosteroids and corticosteroids/cyclophosphamide. We employed binary logistic regression analysis to investigate factors influencing disease progression, gauged by glomerular filtration rate (GFR) decline and the doubling of serum creatinine values over time. The mean follow-up duration was 69.60 ± 22.19 months.
Our study cohort comprised 125 individuals with IgA nephropathy, including 88 men and 37 women, with an average age of 35.94 ± 11.91 years, with a predominance of males. During the follow-up, 20 patients (17%) progressed to end-stage renal disease (eGFR < 20 ml/min), while 23 patients (18.4%) exhibited confirmed kidney disease progression, as indicated by the doubling of serum creatinine levels. Neither method for assessing disease progression demonstrated a statistically significant correlation with ACE inhibitors or corticosteroid treatment. However, a significant correlation was identified between disease progression over time and treatment with azathioprine, patients treated with this medication demonstrated statistically significant improvements. Conversely, treatment modality did not correlate with disease progression based on serum creatinine doubling. GFR-based disease progression over time exhibited a statistically significant correlation with the therapeutic approach employed, including seven variants: supportive care, treated with ACE inhibitors/ARBs, treated with corticosteroids, ACE inhibitors+corticosteroids, corticosteroids+azathioprine, corticosteroids+cyclophosphamide, and corticosteroids+cyclophosphamide+azathioprine. This correlation manifested as a higher relative proportion of non-progressing patients treated with ACE inhibitors+corticosteroids (p=0.017) and a higher percentage of progressing patients treated with corticosteroids+cyclophosphamide (p<0.001).
Treatment with ACE inhibitors and corticosteroids did not demonstrate statistically significant correlations with either method of assessing disease progression, challenging the conventional wisdom regarding these treatments. While IgAN remains the most prevalent form of glomerulonephritis, the optimal treatment approach remains a matter of ongoing debate