Corticosteroid Effects in IgA Nephropathy by Baseline Proteinuria and Estimated GFR
Bibliographic record
Abstract
Introduction Higher proteinuria and lower estimated glomerular filtration rate (eGFR) are predictors of kidney failure in IgA nephropathy (IgAN); however, it is uncertain whether these markers modify response to corticosteroids. This post hoc analysis of the TESTING trial assessed the effects of methylprednisolone on kidney and safety outcomes by baseline proteinuria and eGFR. Methods A total of 503 participants with IgAN and proteinuria ≥ 1 g/d were randomized to oral methylprednisolone (full-dose 0.6–0.8 mg/kg/d or reduced-dose 0.4 mg/kg/d) versus placebo. Participants were categorized according to baseline proteinuria (1–< 1.5, 1.5–< 3, ≥ 3 g/d) and eGFR (20–< 30, 30–< 45, 45–< 60, 60–120 ml/min per 1.73 m 2 ). Results Over a mean follow-up of 4.2 years, methylprednisolone lowered the risk of the primary outcome (≥ 40% decline in eGFR, kidney failure, or death because of kidney disease) by 47% (hazard ratio: 0.53, 95% confidence interval [CI]: 0.39–0.72), with consistent effects regardless of baseline proteinuria ( P -interaction = 0.53) or eGFR ( P -interaction = 0.68). Similarly, methylprednisolone improved the decline in total eGFR slope and reduced proteinuria, regardless of baseline proteinuria or eGFR (all P -interaction > 0.10). The number of serious adverse events (SAEs) was higher with methylprednisolone than with placebo across all proteinuria and eGFR levels. Absolute benefits and harms varied by eGFR, such that for those with eGFR < 30 ml/min per 1.73 m 2 , absolute risk of SAEs may outweigh potential advantages. However, this subgroup was small, predominantly received full-dose methylprednisolone, and was older than those with eGFR ≥ 30 ml/min per 1.73 m 2 . Conclusion Methylprednisolone improves kidney outcomes in IgAN at high risk of progression, irrespective of proteinuria or eGFR, although the risk-benefit balance may be less favorable in those with advanced disease plus other risk factors for corticosteroid-related toxicities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".