BACKGROUND: The European STOP study showed that glucocorticoids (with/without immunosuppressants) did not delay disease progression in adults with IgA nephropathy (IgAN). However, pediatric IgAN is characterized by more severe acute inflammatory lesions and milder chronic injuries. This study aimed to evaluate the effects of glucocorticoid‑based immunosuppressive therapy in children with IgAN using paired renal biopsy data. METHODS: A retrospective analysis was performed in 36 pediatric IgAN patients who underwent repeat renal biopsies. Patients were stratified by initial crescent status: Group A (no crescents, n = 14) and Group B (cellular/cellular‑fibrous crescents, n = 22). Clinical and pathological changes before and after immunosuppressive therapy were analyzed. MEST‑C scores (semi‑quantitative ordinal variables) were analyzed using the Wilcoxon signed‑rank test. Multiple comparisons were not adjusted due to the exploratory design. RESULTS: No significant changes were observed in blood pressure, eGFR, hemoglobin, uric acid, or urinary red blood cell count in either group. Group A showed no significant changes in IgA/C3 deposition or M/E/S/T/C scores. In Group B, serum albumin was significantly increased, and cholesterol and 24‑hour urinary protein were significantly decreased (all p < 0.05). C3 immunofluorescence intensity and E/T/C pathological scores were significantly reduced (all p < 0.05). At repeat biopsy, 16/22 patients in Group B had no residual crescents. Global glomerulosclerosis, focal segmental sclerosis, and capillary loop adhesion remained unchanged in both groups. CONCLUSION: In children with IgAN, immunosuppressive therapy significantly alleviates proteinuria and reverses acute glomerular lesions including crescents and endothelial hypercellularity. However, eGFR, hematuria, and blood pressure were not significantly improved, suggesting that beneficial effects are mainly confined to proteinuria and acute histological remission, without proven long‑term renal protection. Established chronic lesions are not reversible. This study is limited by a small single‑center sample, selection bias from repeat biopsy indications, and lack of randomization or a control group; findings may not be generalizable to the overall pediatric IgAN population.
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