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 (estimated glomerular filtration rate of <15 mL/min/1.73 m2 or long-term kidney replacement therapy). Time-to-event analysis compared outcomes between steroid-treated and untreated patients. Univariable logistic regression and multivariable Cox models identified mortality predictors. Receiver operating characteristic 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. Steroids were used in 62% of patients and were associated with higher rate of skin/soft tissue infections (26% vs. 11%, p = 0.03). Despite similar baseline characteristics, multivariable Cox regression showed that steroid use was independently associated with lower mortality (HR 0.08, 95% CI: 0.01–0.61, p = 0.02). Kaplan-Meier analysis demonstrated significantly lower overall survival in patients receiving cumulative prednisolone ≥73 mg/kg or no steroids, with the best survival observed in those receiving <73 mg/kg (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 ≥73 mg/kg increase mortality risk. Low-dose corticosteroids may be beneficial in severe PIGN, but further research is needed to refine dosing strategies.