Glomerular Diseases · Published 2026-06-22 · DOI 10.1159/000553107
Abhinav Sharma, Adnan Fatfat, Ishaan Batish, Md Shahrier Amin, LaTonya J. Hickson, Nabeel Aslam, Shane A. Bobart
Introduction: IgA nephropathy (IgAN) is a common cause of chronic kidney disease (CKD) worldwide. However, patients with advanced CKD and significant fibrosis on biopsy have limited treatment options, and clinical trials studying targeted-release budesonide have excluded individuals with low estimated glomerular filtration rate (eGFR). Case presentation: We report a case of a 36-year-old male with biopsy-proven crescentic IgAN, initially diagnosed three years prior, who presented with progressive renal dysfunction and persistent proteinuria despite prior treatment with immunosuppression, including corticosteroids and rituximab. At evaluation, serum creatinine was 2.86 mg/dL with an eGFR of 28 mL/min/1.73 m², urine protein to creatinine ratio was 1.64 grams/day and microscopic hematuria was present. Repeat kidney biopsy demonstrated significant chronic changes with severe interstitial fibrosis and tubular atrophy. The Oxford classification score was M1, E1, S1, T2, C1. Targeted-release budesonide was initiated, after which hematuria resolved within one month, proteinuria decreased significantly reaching 0.29 g/day, and kidney function improved with a serum creatinine of 2.24 mg/dL and eGFR of 38 mL/min/1.73 m² at eight months into treatment. The patient tolerated therapy without major adverse events. Conclusion: This case demonstrates clinically meaningful improvement in both proteinuria and renal function following treatment with targeted-release budesonide, despite advanced chronicity but with disease acitivity and low eGFR, a population that remains underrepresented in clinical trials and prospective studies. Our findings highlight the importance of repeat biopsy and future studies addressing the potential benefit of targeted-release budesonide in select patients with advanced IgAN, who may retain a therapeutically targetable inflammatory component.
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Sharma, A., Fatfat, A., Batish, I., et al. (2026). How Late Is Too Late? Successful Use of Targeted-Release Budesonide in IgA Nephropathy with Estimated Glomerular Filtration Rate <30 mL/min/1.73 m 2. Glomerular Diseases. https://doi.org/10.1159/000553107