The Association of Glomerular Glucocorticoid Receptor Expression with Responsiveness to Corticosteroid Treatment in IgA Nephropathy

Youn Kyung Kee, Bo Young Nam, Jong Hyun Jhee, Jung Tak Park, Beom Jin Lim, Tae Hyun Yoo, Shin Wook Kang, Hyun Joo Jeong, Seung Hyeok Han

Research output: Contribution to journalArticle

Abstract

Background: Corticosteroids can be used to treat IgA nephropathy (IgAN). However, responsiveness to these drugs is highly variable and unpredictable. Corticosteroids act by binding glucocorticoid receptors (GCRs). Therefore, we evaluated the association between GCR expression and responsiveness to corticosteroid treatment in IgAN. Methods: We screened 78 IgAN patients receiving steroid treatment between 2010 and 2016. Of these, 33 patients met study inclusion criteria. Glomerular GCR expression was assessed by real-time polymerase chain reaction. Complete remission (CR) and partial remission (PR) were defined as a spot urine protein-to-creatinine ratio (UPCR) of <0.3 g/g and a ≥50% reduction of proteinuria from baseline along with UPCR of ≥0.3 g/g, respectively. Disease progression was defined as a ≥30% decrease in estimated glomerular filtration rate (eGFR) from baseline. Results: The mean age of study patients was 43.9 ± 11.6 years (25 males and 8 females). All 33 patients responded to steroid treatment; CR and PR occurred in 14 (42.4%) and 18 (54.5%) patients, respectively. One patient did not achieve PR, but proteinuria was decreased after treatment. There were no significant differences in baseline eGFR and proteinuria between CR and non-CR groups. GCR mRNA expression was significantly higher in the CR group compared to that in the non-CR group. Immunohistochemistry confirmed higher GCR expression in the CR group. During a median follow-up of 20.6 months, 1 (7.1%) patient in the CR group had disease progression, as compared to 8 (42.1%) patients in non-CR group (p = 0.03). Conclusion: This study suggests that responsiveness to corticosteroid may differ depending on the degree of glomerular GCR expression in IgAN.

Original languageEnglish
Pages (from-to)187-195
Number of pages9
JournalAmerican Journal of Nephrology
Volume50
Issue number3
DOIs
Publication statusPublished - 2019 Sep 1

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Glucocorticoid Receptors
Immunoglobulin A
Adrenal Cortex Hormones
Proteinuria
Therapeutics
Glomerular Filtration Rate
Disease Progression
Creatinine
Steroids
Urine
Real-Time Polymerase Chain Reaction
Proteins
Immunohistochemistry
Messenger RNA
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Kee, Youn Kyung ; Nam, Bo Young ; Jhee, Jong Hyun ; Park, Jung Tak ; Lim, Beom Jin ; Yoo, Tae Hyun ; Kang, Shin Wook ; Jeong, Hyun Joo ; Han, Seung Hyeok. / The Association of Glomerular Glucocorticoid Receptor Expression with Responsiveness to Corticosteroid Treatment in IgA Nephropathy. In: American Journal of Nephrology. 2019 ; Vol. 50, No. 3. pp. 187-195.
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title = "The Association of Glomerular Glucocorticoid Receptor Expression with Responsiveness to Corticosteroid Treatment in IgA Nephropathy",
abstract = "Background: Corticosteroids can be used to treat IgA nephropathy (IgAN). However, responsiveness to these drugs is highly variable and unpredictable. Corticosteroids act by binding glucocorticoid receptors (GCRs). Therefore, we evaluated the association between GCR expression and responsiveness to corticosteroid treatment in IgAN. Methods: We screened 78 IgAN patients receiving steroid treatment between 2010 and 2016. Of these, 33 patients met study inclusion criteria. Glomerular GCR expression was assessed by real-time polymerase chain reaction. Complete remission (CR) and partial remission (PR) were defined as a spot urine protein-to-creatinine ratio (UPCR) of <0.3 g/g and a ≥50{\%} reduction of proteinuria from baseline along with UPCR of ≥0.3 g/g, respectively. Disease progression was defined as a ≥30{\%} decrease in estimated glomerular filtration rate (eGFR) from baseline. Results: The mean age of study patients was 43.9 ± 11.6 years (25 males and 8 females). All 33 patients responded to steroid treatment; CR and PR occurred in 14 (42.4{\%}) and 18 (54.5{\%}) patients, respectively. One patient did not achieve PR, but proteinuria was decreased after treatment. There were no significant differences in baseline eGFR and proteinuria between CR and non-CR groups. GCR mRNA expression was significantly higher in the CR group compared to that in the non-CR group. Immunohistochemistry confirmed higher GCR expression in the CR group. During a median follow-up of 20.6 months, 1 (7.1{\%}) patient in the CR group had disease progression, as compared to 8 (42.1{\%}) patients in non-CR group (p = 0.03). Conclusion: This study suggests that responsiveness to corticosteroid may differ depending on the degree of glomerular GCR expression in IgAN.",
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The Association of Glomerular Glucocorticoid Receptor Expression with Responsiveness to Corticosteroid Treatment in IgA Nephropathy. / Kee, Youn Kyung; Nam, Bo Young; Jhee, Jong Hyun; Park, Jung Tak; Lim, Beom Jin; Yoo, Tae Hyun; Kang, Shin Wook; Jeong, Hyun Joo; Han, Seung Hyeok.

In: American Journal of Nephrology, Vol. 50, No. 3, 01.09.2019, p. 187-195.

Research output: Contribution to journalArticle

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T1 - The Association of Glomerular Glucocorticoid Receptor Expression with Responsiveness to Corticosteroid Treatment in IgA Nephropathy

AU - Kee, Youn Kyung

AU - Nam, Bo Young

AU - Jhee, Jong Hyun

AU - Park, Jung Tak

AU - Lim, Beom Jin

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

AU - Jeong, Hyun Joo

AU - Han, Seung Hyeok

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N2 - Background: Corticosteroids can be used to treat IgA nephropathy (IgAN). However, responsiveness to these drugs is highly variable and unpredictable. Corticosteroids act by binding glucocorticoid receptors (GCRs). Therefore, we evaluated the association between GCR expression and responsiveness to corticosteroid treatment in IgAN. Methods: We screened 78 IgAN patients receiving steroid treatment between 2010 and 2016. Of these, 33 patients met study inclusion criteria. Glomerular GCR expression was assessed by real-time polymerase chain reaction. Complete remission (CR) and partial remission (PR) were defined as a spot urine protein-to-creatinine ratio (UPCR) of <0.3 g/g and a ≥50% reduction of proteinuria from baseline along with UPCR of ≥0.3 g/g, respectively. Disease progression was defined as a ≥30% decrease in estimated glomerular filtration rate (eGFR) from baseline. Results: The mean age of study patients was 43.9 ± 11.6 years (25 males and 8 females). All 33 patients responded to steroid treatment; CR and PR occurred in 14 (42.4%) and 18 (54.5%) patients, respectively. One patient did not achieve PR, but proteinuria was decreased after treatment. There were no significant differences in baseline eGFR and proteinuria between CR and non-CR groups. GCR mRNA expression was significantly higher in the CR group compared to that in the non-CR group. Immunohistochemistry confirmed higher GCR expression in the CR group. During a median follow-up of 20.6 months, 1 (7.1%) patient in the CR group had disease progression, as compared to 8 (42.1%) patients in non-CR group (p = 0.03). Conclusion: This study suggests that responsiveness to corticosteroid may differ depending on the degree of glomerular GCR expression in IgAN.

AB - Background: Corticosteroids can be used to treat IgA nephropathy (IgAN). However, responsiveness to these drugs is highly variable and unpredictable. Corticosteroids act by binding glucocorticoid receptors (GCRs). Therefore, we evaluated the association between GCR expression and responsiveness to corticosteroid treatment in IgAN. Methods: We screened 78 IgAN patients receiving steroid treatment between 2010 and 2016. Of these, 33 patients met study inclusion criteria. Glomerular GCR expression was assessed by real-time polymerase chain reaction. Complete remission (CR) and partial remission (PR) were defined as a spot urine protein-to-creatinine ratio (UPCR) of <0.3 g/g and a ≥50% reduction of proteinuria from baseline along with UPCR of ≥0.3 g/g, respectively. Disease progression was defined as a ≥30% decrease in estimated glomerular filtration rate (eGFR) from baseline. Results: The mean age of study patients was 43.9 ± 11.6 years (25 males and 8 females). All 33 patients responded to steroid treatment; CR and PR occurred in 14 (42.4%) and 18 (54.5%) patients, respectively. One patient did not achieve PR, but proteinuria was decreased after treatment. There were no significant differences in baseline eGFR and proteinuria between CR and non-CR groups. GCR mRNA expression was significantly higher in the CR group compared to that in the non-CR group. Immunohistochemistry confirmed higher GCR expression in the CR group. During a median follow-up of 20.6 months, 1 (7.1%) patient in the CR group had disease progression, as compared to 8 (42.1%) patients in non-CR group (p = 0.03). Conclusion: This study suggests that responsiveness to corticosteroid may differ depending on the degree of glomerular GCR expression in IgAN.

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