An international, double-blind, randomized clinical trial in 67 centers from Australia, Canada, China, India and Malaysia. 503 participants with IgA nephropathy, proteinuria ≥1 g per day, and eGFR of 20 to 120 mL/min after at least 3 months of optimized background care were enrolled and randomized to oral methylprednisolone 0.4 mg/kg/d (with a maximum dose of 32 mg/d, weaning by 4 mg/d/mo) or placebo. Antibiotic prophylaxis for pneumocystis pneumonia was given for both groups. Mean follow up period was 4.2 years. Primary end point was a composite of 40% decline in eGFR, kidney failure (dialysis, transplant), or death due to kidney disease. Treatment with steroids reduced the risk of composite renal outcome compared to placebo. However, there was an increase incidence of serious adverse events with high dose steroid therapy.
