a
The Therapeutic Evaluation of Steroids in IgA Nephropathy Global (TESTING) study
included patients with eGFR 20–30 ml/min per 1.73 m
2
, but only 26 patients in total
had this range of kidney function. Prespecified subgroup analyses for signals of
efficacy and toxicity were underpowered and did not distinguish patients with eGFR
<30 ml/min per 1.73 m
2
.
b
High BMI in the TESTING study was not specifically considered an exclusion, but the
mean BMI was 24 kg/m
2
.
Diabetes
Latent infections (e.g., viral hepatitis, TB)
Active peptic ulceration
Severe osteoporosis
eGFR <30 ml/min/1.73 m
2
a
Obesity (body mass index [BMI] >30 kg/m
2
)
b
Secondary disease (e.g., cirrhosis)
Uncontrolled psychiatric illness
Practice Point 2.3.1.3
Use of glucocorticoids in IgAN
• Clinical benefit of glucocorticoids in IgAN is not established and
should be given with extreme caution or avoided entirely in situations
listed in Figure 3.
• There is insufficient evidence to support the use of the Oxford Classification
MEST-C score in determining when any glucocorticoid therapy should be
commenced.
• There are no data to support efficacy or reduced toxicity of alternate-day
glucocorticoid regimens, or dose reduced protocols.
• Where appropriate, treatment with glucocorticoid (prednisone equivalent
≥0.5 mg/kg/d) should incorporate prophylaxis against Pneumocystis pneumonia
along with gastroprotection and bone protection, according to local guidelines.
Figure 3. Situations When Glucocorticoids Should be Avoided,
or Administered With Great Caution
Treatment
