Усиление иммуносупрессии не улучшает прогноз при быстропрогрессирующем вторичном IgA-нефропатии

TOPLINE A cohort study found that patients with rapidly progressive secondary immunoglobulin A nephropathy (IgAN) had a poor prognosis, with more than one third progressing to kidney failure and more than one third dying during the median follow-up period of 36 months. Escalating immunosuppressive therapy beyond corticosteroids was not associated with improved renal or patient survival. METHODOLOGY - Researchers conducted a retrospective cohort study across 12 nephrology centres in Spain to examine renal survival, prognostic factors, and the effect of corticosteroids and additional immunosuppressive therapy in adults with rapidly progressive secondary IgAN. - They included 92 patients (mean age, 61.0 years; 82.6% men) with acute kidney injury or rapidly progressive kidney disease (defined as a decline in the estimated glomerular filtration rate [eGFR] of ≥ 50% from baseline within less than 3 months) and biopsy-proven rapidly progressive secondary IgAN associated with systemic diseases. - Patients received supportive care alone (n = 22), supportive care plus corticosteroids (n = 36), or supportive care plus corticosteroids and additional immunosuppressive agents (n = 34). - The primary outcome was renal survival, defined as survival free from kidney failure (sustained eGFR < 15 mL/min/1.73 m2 or the need for chronic kidney replacement therapy). Secondary outcomes included patient survival (all-cause mortality) and the identification of clinical and histologic factors associated with renal outcomes. - Patients who survived and remained free from kidney failure through day 30 (or day 14 in sensitivity analyses) after biopsy were classified by treatment group and subsequently followed up for kidney failure as the outcome. TAKEAWAY - The mean eGFR at presentation was 16.9 mL/min/1.73 m2, and 31.5% of patients required dialysis at presentation. Over a median follow-up duration of 36 months, 34.8% of patients developed kidney failure and 37% died. - Treatment escalation with corticosteroids and additional immunosuppressive therapy was not associated with a reduced risk for progression to kidney failure in weighted analyses (subdistribution hazard ratio [SHR], 1.09; P = .88 at a 30-day landmark and SHR, 1.40; P = .54 at a 14-day landmark). - Treatment escalation was also not associated with a reduced risk for all-cause mortality (HR, 1.20; P = .78 at a 30-day landmark and HR, 1.14; P = .84 at a 14-day landmark). - Liver disease (adjusted HR [aHR], 3.16; P = .038) and dialysis at presentation (aHR, 4.20; P = .009) were identified as independent predictors of progression to kidney failure. IN PRACTICE "[The study] findings support a cautious and individualized approach to immunosuppressive escalation in this setting and highlight the importance of developing dedicated prospective studies to better define optimal management strategies for this high-risk population," the authors wrote. SOURCE This study was led by Amir Shabaka, Hospital Universitario La Paz, Madrid, Spain. It was published online on July 06, 2026, in Nephrology Dialysis Transplantation. LIMITATIONS The retrospective and observational design may have introduced confounding. Treatment regimens were heterogeneous across centres in terms of the dosing, duration, and choice of immunosuppressive agents. Additionally, histopathologic evaluation was conducted locally without central review, which may have led to interobserver variability. DISCLOSURES This study did not receive any external funding. The authors reported having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.