The Therapeutic Evaluation of Steroids in IgA Nephropathy Global (TESTING) Study - Canadian Network

IgA nephropathy (IgAN) is a common cause of renal disease in Canada, especially amongst younger and otherwise healthy Canadians. The risk of progression to dialysis or transplantation in IgAN is significant, approximately 35% after 10 years, highlighting the need to identify treatments capable of reducing this risk. Several small, inconclusive studies have suggested that treatment of IgAN with a short course of steroids (such as methylprednisolone) may reduce the risk of renal function decline. A large randomized controlled trial is therefore needed to more definitively describe the benefits of steroids in IgAN. We propose to create a Canadian network to recruit patients with IgAN to study the effect of steroid vs. placebo on progression of kidney disease. This study will utilize the infrastructure of a larger multi-centre study to develop a Canadian network for clinical trials and translational research in glomerular disease. All patients will receive the currently established standard of care for patients with IgAN, namely aggressive blood pressure control with medications that also reduce protein in the urine. We will follow patients for 6 years for the risk of progression to dialysis, kidney transplantation, a 50% reduction in renal function, or death due to kidney disease. We anticipate that patients treated with methylprednisolone will experience these renal outcomes 30% less often than those given placebo. This will be a large international trial recruiting 1300 patients from Canada, China, India, Australia and the United Kingdom and will be the largest ever conducted in patients with IgAN. This funding application is to support the recruitment of patients from Canadian centres.