The role of glucocorticoid receptor expression in kidney in clinical progress of patients with iga nephropathy: Single-center exprience

Aim: Glucocorticoids are used as the primary treatment in IgA nephropathy, and they manifest their effects by binding to intracellular glucocorticoid receptors. Studies have shown that GCR expression correlates with degree of response to steroid in various diseases. Therefore, this study aimed to evaluate if responsiveness to steroids in IgAN patients is altered depending on GCR expression. Materials and methods: This study included 110 patients with biopsy proven primary IgA nephropathy who were also followed up by the Nephrology outpatient clinic of Çukurova University Faculty of Medicine between 2002-2019. GCR expression was determined immunohistochemically, and then the clinical and laboratory progress of the patients was evaluated from the beginning of steroid therapy. Findings: No significant results were obtained in comparing demographic and laboratory data according to the glucocortikoid receptor staining degree. In kidney biopsy Glucocorticoid Receptor expression was compared with the MEST score; In patients with mesangial proliferation (M1), it was determined that the glucocorticoid receptor was stained more intensely with 33 (41.8%) than those with M0.. At the time of diagnosis; high systolic and diastolic blood pressure, increased white blood cell, neutrophil count, MCV and Mentzer index increased serum levels of PTH, BUN, creatinine, uric acid, potassium, magnesium, total cholesterol, LDL levels, , high sclerosis rate in biopsy, lower serum total protein level and decreased eGFR value were found to be poor prognostic factors. Therefore, glucocortikoid receptor staining rates were observed to have no effect on prognosis Conclusion: No correlation was found between the rate of GCR staining and prognosis in patients with IgA nephropathy. M1 was higher in those with high GCR expression. Patients with high proteinuria, low eGFR, and high blood pressure at baseline, who were determined to have a poor prognosis, had higher MEST scores for E, S, and T. Larger studies are needed to evaluate the effect of GCR expression in the treatment or clinical course of IgA nephropathy. Keywords: IgA nephropathy, glucocorticoid receptor, steroid