A Cochrane review «»? (abstract «»1, review «Immunosuppressive agents for treating IgA nephropathy»?) included 58 studies with a total of 3 933 patients. In patients with proteinuria > 1 g/day, steroids were associated with a lower risk of progression to end-stage kidney disease (ESKD) (RR 0.39, 95% CI 0.23 to 0.65; 8 trials, n=741) and lower urinary protein excretion (MD -0.58 g/24 h, 95% CI -0.84 to -0.33; 10 trials, n=705) compared to no treatment or placebo. Steroid therapy induced complete remission (RR 1.76, 95% CI 1.03 to 3.01; 4 studies, n=305). Cytotoxic agents azathioprine or cyclophosphamide, mycophenolate mofetil, and calcineurin inhibitors had uncertain effects on ESKD, complete remission, and protein excretion.
Comment: The quality of evidence is downgraded by study limitations.