Delayed-Release Budesonide in a Patient With Progressive IgA Nephropathy and Stage 4 Chronic Kidney Disease: A Case Report.

Publisher: Sage on behalf of: American Federation for Medical Research Country of Publication: United States NLM ID: 101624758 Publication Model: Print Cited Medium: Internet ISSN: 2324-7096 (Electronic) Linking ISSN: 23247096 NLM ISO Abbreviation: J Investig Med High Impact Case Rep Subsets: MEDLINE

Original Publication: [Thousand Oaks, CA] : Sage on behalf of: American Federation for Medical Research

Budesonide*/administration & dosage ; Budesonide*/therapeutic use ; Glomerulonephritis, IGA*/drug therapy ; Glomerulonephritis, IGA*/complications ; Delayed-Action Preparations* ; Glomerular Filtration Rate* ; Renal Insufficiency, Chronic*/complications ; Renal Insufficiency, Chronic*/drug therapy ; Disease Progression* ; Proteinuria*/drug therapy; Humans ; Male ; Adult ; Glucocorticoids/administration & dosage ; Glucocorticoids/therapeutic use

Delayed-release (DR) budesonide received expedited approval from the US Food and Drug Administration (FDA) as a treatment for reducing proteinuria in individuals with primary IgA nephropathy (IgAN) who are at significant risk of disease progression. The approval was based on clinical trials primarily involving patients with an estimated glomerular filtration rate (eGFR) greater than 30 mL/min/1.73 m ² . However, the efficacy of DR budesonide in reducing kidney function decline, especially in patients with an eGFR less than 30 mL/min/1.73 m ² and proteinuria less than 1 g/d, remains unclear. We report the case of a 43-year-old man with a long-term history of hypertension and biopsy-proven IgAN who experienced a progressive increase in proteinuria and serum creatinine, along with a decline in eGFR to 28 mL/min/1.73 m ² despite maximal supportive management. Following therapy with DR budesonide, a decreasing trend in proteinuria and a stabilization of eGFR were observed in the recent measurements. While initial data suggested the effectiveness of DR budesonide primarily in patients with an eGFR over 30 mL/min/1.73 m ² , our case demonstrates the potential of DR budesonide for use in scenarios beyond its currently approved indications. This underscores the need for additional research on patients with advanced stages of chronic kidney disease.
Competing Interests: Declaration of Conflicting InterestsDr. Sayna Norouzi serves as a consultant and a member of the speaker’s bureau for Calliditas Therapeutics AB.

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Keywords: IgA nephropathy; chronic kidney disease; delayed-release budesonide; estimated glomerular filtration rate; proteinuria

51333-22-3 (Budesonide)
0 (Delayed-Action Preparations)
0 (Glucocorticoids)

Date Created: 20240613 Date Completed: 20240613 Latest Revision: 20240627

20240627

PMC11177723

10.1177/23247096241260964

38869105