Efficacy of methylprednisolone pulse therapy in Chinese children with IgA vasculitis-associated nephritis (IgAVN)

Background: One of the most common secondary glomerular diseases in children is IgA vasculitis-associated nephritis (IgAVN). Determining the best treatment for IgAVN based on current guidelines is controversial. The purpose of this study was to evaluate the efficacy of methylprednisolone pulse therapy in Chinese children with moderate and severe IgAVN.

Methods: We compared outcomes between 86 children with IgAVN who received methylprednisolone pulse therapy (40 patients) and those who did not (46 patients). Both groups of patients were monitored for a minimum of one year. Laboratory results including 24-h proteinuria, serum albumin, serum creatinine, and clinical symptoms including edema and adverse reactions were compared.

Results: The average age of the children in the group receiving methylprednisolone pulse therapy was 8.71 ± 2.71 years, while the average age in those who did not receive pulse therapy was 8.48 ± 3.02 years. Methylprednisolone pulse treatment resulted in a longer-lasting reduction in urinary protein levels and in reduced recurrence rates and increased remission rates at 3 and 6 months (methylprednisolone: 65% and 85% versus no methylprednisolone: 43.48% and 67.39%, respectively). The recurrence rate within one year also differed significantly between the two groups. Within one year, 25% of children receiving methylprednisolone pulse therapy relapsed, whereas 43.5% of children not receiving methylprednisolone pulse therapy relapsed.

Conclusions: In Chinese children with moderate to severe IgAVN, methylprednisolone pulse therapy achieved a significantly higher remission rate and a more rapid eGFR improvement than non-methylprednisolone pulse therapy. Prompt initiation of methylprednisolone pulse therapy for children diagnosed with moderate to severe IgAVN may therefore be recommended.