Corticosteroid Therapy and the Risk of Kidney Failure in IgA Nephropathy: A Dose- and Ethnicity-Stratified Meta-Analysis of Randomised Controlled Trials

Abstract

Introduction. Corticosteroids are widely used in IgA nephropathy, but their net benefit is contested because the largest trials show both protection against kidney-function decline and excess serious infection; the optimal dose and consistency across ethnic groups are uncertain. This study was aimed to quantify the effect of systemic corticosteroids on the risk of kidney failure in IgA nephropathy and to explore modification by dose and ethnicity (PICO: biopsy-proven IgA nephropathy; systemic corticosteroids with or without renin-angiotensin system blockade; supportive care or placebo; kidney failure and proteinuria).

Methods. Four databases were searched from inception for randomised controlled trials. Risk ratios (RR) were pooled with a DerSimonian-Laird random-effects model and proteinuria as Hedges’ g; heterogeneity was assessed with I² and a prediction interval, bias with RoB 2 and the Egger test, and certainty with GRADE. The review was not registered.

Results. Ten non-overlapping trials (1,153 participants; 104 vs 165 events) were included. Corticosteroids reduced the risk of kidney failure (RR 0.61, 95% CI 0.42–0.90; I² = 21%; p = 0.012), remaining significant under the Hartung-Knapp correction (0.39–0.97); a dose subgroup difference was significant (p = 0.010, larger effect with high-dose regimens). Proteinuria fell moderately (Hedges’ g −0.68, −1.00 to −0.35). Serious infection was more frequent with corticosteroids.

Conclusion. Corticosteroids reduce kidney failure and proteinuria but increase serious infection; a reduced-dose strategy preserves benefit while improving safety, supporting individualised, risk-stratified use.