IV methylprednisolone pulse no better than oral steroids alone for tubulointerstitial nephritis

The key findings of this study were:

1. For this study, 40 participants were randomly assigned. Prior to PRD, baseline eGFR was 22 mL/min/1.73 m2, and prior to MP, it was 25 mL/min/1.73 m2.

2. The mean percentage of interstitial fibrosis and the degree of the interstitial infiltration in the two groups did not differ.

3. The median eGFR at 3 months in the population being treated, consisting of the PRD and MP groups, was 45 and 46 mL/min/1.73m2, respectively.

4. 16 of 20 PRD patients and 10 of 20 MP patients met the primary end point at 3 months. After 1, 3, 6, and 12 months of treatment, there was little difference in the eGFR between the two groups.

5. The eGFR at 1 month and the eGFR at 12 months for both groups showed a significant correlation.

6. The severity of the adverse events was the same for the two groups.

Over a conventional oral corticosteroid regimen, this tactic did not provide any additional benefits for kidney health. The pathophysiological mechanisms underlying renal lesions should be better understood to produce more targeted and efficient treatments.

Reference:

Mahevas, M., Audard, V., Rousseau, A., Cez, A., Guerrot, D., Verhelst, D., Delahousse, M., Hanrotel, C., Pillebout, E., Daugas, E., Krastinova, E., Valeyre, D., Jean-Marc, N., … Sandrine, H. (2022). Efficacy and safety of methylprednisolone pulse followed by oral prednisone vs. oral prednisone alone in sarcoidosis tubulointerstitial nephritis: a randomized, open-label, controlled clinical trial. In Nephrology Dialysis Transplantation (Vol. 38, Issue 4, pp. 961–968). Oxford University Press (OUP). https://doi.org/10.1093/ndt/gfac227