Low-Dose Spironolactone found Effective for Proteinuria Reduction in IgA Nephropathy, suggests study

Results: 88 patients were analyzed and 24h-proteinuria decreased from 0.93g to 0.70 g (p＜0.001) after two-months of treatment with spironolactone, accompanied by a slight decrease in EPI-eGFR from 75.7 to 73.9 mL/min/1.73 m2 (p = 0.033). Intriguingly, 47 patients in effective MRA group showed less endocapillary hypercellularity (p = 0.040). In ineffective group, 18 patients discontinued MRA treatment because of 24h-proteinuria increased from 0.83 g to 1.04 g, while the other 23 patients were continued with spironolactone and proteinuria decreased to 0.57 g in the sixth month (p = 0.001). Furthermore, 12 patients with persistent high proteinuria during prednisone therapy, were added with spironolactone. 24-proteinuria were dropped from 0.95 g to 0.73 g at the second month, and to 0.50 g at the sixth month. Conclusions: In our study, we confirmed spironolactone's efficacy in reducing urine protein excretion in IgA nephropathy patients within two months of treatment. However, response varied among patients, with those showing endocapillary proliferation (E1) in renal biopsies having poor spironolactone responsiveness. Administering mineralocorticoid receptor antagonists (MRAs) to patients with eGFR over 30 ml/min did not result in hyperkalemia, indicating the treatment's safety.

Reference:

Da Shang, Yi Guan, Shaojun Liu, ChuanMing Hao, Lingyun Lai; Effectiveness and Safety of Spironolactone in the Treatment of IgA Nephropathy: A Retrospective Self-Controlled Study. Kidney Blood Press Res 2024; https://doi.org/10.1159/000540283