Evaluating the Potential Role of Corticosteroids in Post-Infectious Glomerulonephritis

Introduction: Corticosteroids are commonly used in severe post-infectious glomerulonephritis (PIGN), but the optimal dosing and long-term outcomes remain unclear. This study investigated the association between cumulative corticosteroid dosage and mortality in patients with biopsy-proven PIGN. Methods: This retrospective cohort study included adult patients (≥18 years) with biopsy-proven PIGN from the King Chulalongkorn Memorial Hospital registry (1996–2023), excluding those with concurrent infections or conditions affecting prognosis. Clinical and histopathological data were collected. The primary outcome was kidney failure (eGFR <15 mL/min/1.73m² or long-term KRT). Time-to-event analysis compared outcomes between steroid-treated and untreated patients. Univariable logistic regression and multivariable Cox models identified mortality predictors. ROC curves identified the optimal cumulative prednisolone dosage, and Kaplan-Meier analysis compared survival between steroid dosage groups. Results: Among 7,005 kidney biopsies, 73 patients with PIGN were analyzed. Over a median follow-up of 15.6 years, 15% died, and 15% developed kidney failure. Steroid therapy was administered to 62% of patients, with more skin/soft tissue infections in the steroid group (26% vs. 11%, p=0.03), and comparable baseline characteristics. Corticosteroid use significantly reduced mortality (HR 0.08, 95% CI: 0.01–0.61, p=0.02). A cumulative prednisolone dose >73 mg/kg increased mortality (HR 18.36, 95% CI: 1.15–217.33, p=0.02), while lower doses improved survival (Log-rank test, p=0.02). Steroid-related adverse events included cushingoid appearance (11%) and osteopenia (4%). Conclusion: Corticosteroids improve survival in PIGN, but cumulative doses exceeding 73 mg/kg increase mortality risk. Low-dose corticosteroids may be beneficial in severe PIGN, but further research is needed to refine dosing strategies.