The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa

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dc.contributor.authorWearne, Nicola
dc.contributor.authorSwanepoel, Charles R
dc.contributor.authorDuffield, Maureen S
dc.contributor.authorDavidson, Bianca J
dc.contributor.authorManning, Kathryn
dc.contributor.authorTiffin, Nicki
dc.contributor.authorBoulle, Andrew
dc.contributor.authorRayner, Brian L
dc.contributor.authorNaidu, Priyanka
dc.contributor.authorOkpechi, Ikechi G
dc.date.accessioned2019-02-14T16:08:19Z
dc.date.available2019-02-14T16:08:19Z
dc.date.issued2019-02-06
dc.date.updated2019-02-10T04:17:59Z
dc.description.abstractBackground The aim of this study was to assess, the efficacy and safety of add-on corticosteroids to antiretroviral therapy [ART] in patients with biopsy proven HIV associated nephropathy. Methods All included patients had histological evidence of either collapsing or non-collapsing focal segmental glomerulosclerosis (FSGS) or podocyte and/or parietal cell hypertrophy or hyperplasia. All patients had evidence of tubulointerstitial inflammation with microcysts. Patients were randomized to ART with the addition of 1 mg/kg of corticosteroids [ART+C] or remained in the group [ART Alone] and followed for 2 years. A repeat biopsy was performed at 6 months. Results Twenty-one patients were randomized to [ART+C] and 17 to [ART Alone]. The baseline estimated glomerular filtration rate (eGFR) was significantly lower in the [ART+C] vs. [ART Alone] group [35mls/min/1.73m2 vs. 47 mls/min/1.73m2, p = 0.015]. The [ART+C] cohort had a statistically significant improvement in median (eGFR) from baseline to last follow up compared with [ART Alone] i.e. [Δ = 25mls/min (IQR: 15;51) vs 9 mls/min (IQR: 0–24), p = 0.008]. There were no statistically significant differences between the groups when proteinuria and histology were analyzed. There were 8 deaths during the trial period, 7 from [ART+C] (Log rank p = 0.071). Conclusions In the [ART+C] cohort there was a significant improvement in eGFR over 2-years with increased mortality. Routine corticosteroid use cannot currently be recommended. Further investigation to define which subgroup of this cohort would safely benefit from the positive effects is required. Trial registration ISRCTN study ID ( 56112439 ] was retrospectively registered on the 5 September 2018.
dc.identifier.apacitationWearne, N., Swanepoel, C. R., Duffield, M. S., Davidson, B. J., Manning, K., Tiffin, N., ... Okpechi, I. G. (2019). The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa. <i>BMC Nephrology</i>, http://hdl.handle.net/11427/29540en_ZA
dc.identifier.chicagocitationWearne, Nicola, Charles R Swanepoel, Maureen S Duffield, Bianca J Davidson, Kathryn Manning, Nicki Tiffin, Andrew Boulle, Brian L Rayner, Priyanka Naidu, and Ikechi G Okpechi "The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa." <i>BMC Nephrology</i> (2019) http://hdl.handle.net/11427/29540en_ZA
dc.identifier.citationWearne, N., Swanepoel, C. R., Duffield, M. S., Davidson, B. J., Manning, K., Tiffin, N., ... & Okpechi, I. G. (2019). The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa. BMC Nephrology, 20(1), 44.
dc.identifier.ris TY - Journal Article AU - Wearne, Nicola AU - Swanepoel, Charles R AU - Duffield, Maureen S AU - Davidson, Bianca J AU - Manning, Kathryn AU - Tiffin, Nicki AU - Boulle, Andrew AU - Rayner, Brian L AU - Naidu, Priyanka AU - Okpechi, Ikechi G AB - Background The aim of this study was to assess, the efficacy and safety of add-on corticosteroids to antiretroviral therapy [ART] in patients with biopsy proven HIV associated nephropathy. Methods All included patients had histological evidence of either collapsing or non-collapsing focal segmental glomerulosclerosis (FSGS) or podocyte and/or parietal cell hypertrophy or hyperplasia. All patients had evidence of tubulointerstitial inflammation with microcysts. Patients were randomized to ART with the addition of 1 mg/kg of corticosteroids [ART+C] or remained in the group [ART Alone] and followed for 2 years. A repeat biopsy was performed at 6 months. Results Twenty-one patients were randomized to [ART+C] and 17 to [ART Alone]. The baseline estimated glomerular filtration rate (eGFR) was significantly lower in the [ART+C] vs. [ART Alone] group [35mls/min/1.73m2 vs. 47 mls/min/1.73m2, p = 0.015]. The [ART+C] cohort had a statistically significant improvement in median (eGFR) from baseline to last follow up compared with [ART Alone] i.e. [Δ = 25mls/min (IQR: 15;51) vs 9 mls/min (IQR: 0–24), p = 0.008]. There were no statistically significant differences between the groups when proteinuria and histology were analyzed. There were 8 deaths during the trial period, 7 from [ART+C] (Log rank p = 0.071). Conclusions In the [ART+C] cohort there was a significant improvement in eGFR over 2-years with increased mortality. Routine corticosteroid use cannot currently be recommended. Further investigation to define which subgroup of this cohort would safely benefit from the positive effects is required. Trial registration ISRCTN study ID ( 56112439 ] was retrospectively registered on the 5 September 2018. DA - 2019-02-06 DB - OpenUCT DP - University of Cape Town J1 - BMC Nephrology LK - https://open.uct.ac.za PY - 2019 T1 - The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa TI - The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa UR - http://hdl.handle.net/11427/29540 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12882-019-1208-2
dc.identifier.urihttp://hdl.handle.net/11427/29540
dc.identifier.vancouvercitationWearne N, Swanepoel CR, Duffield MS, Davidson BJ, Manning K, Tiffin N, et al. The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa. BMC Nephrology. 2019; http://hdl.handle.net/11427/29540.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.rights.holderThe Author(s).
dc.sourceBMC Nephrology
dc.source.urihttps://bmcnephrol.biomedcentral.com/
dc.subject.otherHIV
dc.subject.otherHIV associated nephropathy
dc.subject.otherCorticosteroids
dc.titleThe effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa
dc.typeJournal Article
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