Delayed-release budesonide combined with cyclophosphamide in a patient with IgA nephropathy with eGFR < 30 mL/min/1.73 m²: A case report.

rationaleDelayed-release budesonide, as a novel oral agent, may be an effective treatment for IgA nephropathy. Its efficacy and safety in adult IgA nephropathy patients with estimated glomerular filtration rate (eGFR) > 35 mL/min/1.73 m² has been previously confirmed in the phase III clinical study (NeflgArd). For patients at high risk of progression to end-stage renal disease, it is uncertain whether delayed-release budesonide combined with cyclophosphamide on the basis of supportive therapy could improve the prognosis of adult IgA nephropathy patients. PATIENT CONCERNS: A 37-year-old male presented with fever (max 38.2°C) and sore throat, urinalysis revealed abnormalities. DIAGNOSES: Laboratory tests showed urinary protein of 2.98 g/d, serum creatinine of 321 μmol/L, eGFR of 20.27 mL/min/1.73 m2, plasma albumin 34.6 g/L. Renal biopsy pathology showed sclerosing IgA nephropathy (Lee grade Ⅳ, Oxford classification M0E0S1T1C0).

interventionsThe patient was treated with delayed-release budesonide (16 mg/d) for 36 weeks, in combination with intravenous cyclophosphamide (0.8 g monthly for 6 months). OUTCOMES: After 36 weeks of therapy, the eGFR increased from 20.27 to 48.12 mL/min/1.73 m2, serum creatinine decreased from 321 to 157 μmol/L, urinary protein decreased from 2.98 to 0.378 g/d, and plasma albumin increased from 34.6 to 45.6 g/L. During the course of treatment, no significant drug-related adverse reactions were observed, except for a mild cold. LESSONS: This case suggests that delayed-release budesonide in combination with cyclophosphamide on the basis of supportive therapy is effective in treating adult IgA nephropathy patient with eGFR < 30 mL/min/1.73 m2. This approach warrants further investigation in larger prospective studies.