#1165 Targeted-release budesonide can preserve the glomerular filtration rate in patients diagnosed with IgA nephropathy after 3 months of administration. (2024)

Background and Aims

The four-hit hypothesis constitutes the main immunological sequence of the IgA nephropathy (IgAN) pathogenesis. However, the activation of intestinal-renal axis is considered the initial step during IgA nephropathy (IgAN) pathogenesis. Aim of this prospective pilot study is to evaluate parameters which influence early response to targeted release budesonide.

Method

Adult IgAN patients, diagnosed the last 10 years, maintaining eGFR >30 ml/min/1.73m² and Uprotein >750 mg/24 hr, despite standard supportive treatment, commenced on budesonide 16 mg/d, and followed for 3 months. Renal biopsies were re-evaluated and scored according to Oxford classification, parameters of renal function recorded at time of diagnosis (T-d),at the beginning of treatment (T0), and 3 months later (T3).

Results

Fifteen IgAN patients, M/F:12/3, Mean age: 52 (34-74) years from two different departments fulfilled the criteria and they have already started on budesonide treatment, 51.6 ± 45 months following diagnosis. eGFR had declined from T-d to T0, 57.43 ± 10.58 to 49.23 ± 13.63 ml/min/1.73 m², p = 0.03, and Uprot was stable 3.33 ± 1.16 to Uprot = 2.98 ± 1.19 gr/24 hrs, p = NS. During the 3 first months of budesonide (T3), eGFR showed slight improvement, eGFR = 54.38 ± 13.67 while Uprot remained stable 3.17 ± 1,04 gr/24 hrs. Improvement in renal function was not associated with any of histologic findings, but was remarkably more evident within patients with <4 years of diagnosis, eGFR from 62 ± 5.2 to 73 ± 2.4, compared to change in the eGFR from 23 ± 5.6 ml/min/1.73 m² to 25 ± 3.6 ml/min/1.73 m².

Conclusion

Our preliminary findings suggest that, independent of renal histology, budesonide treatment showed a trend in improving renal function, mainly in patients with relatively short time from diagnosis. So, budesonide can