{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:49:30Z","timestamp":1779896970910,"version":"3.53.1"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>We describe a case of immunoglobulin A nephropathy (IgAN) treated with targeted-release budesonide (Nefecon) that resulted in notable systemic adverse effects. The patient developed cushingoid features, weight gain, hyperglycaemia and leucocytosis within 3 months of therapy. During dose tapering he experienced symptomatic adrenal insufficiency confirmed by low morning cortisol, requiring hydrocortisone replacement. Despite Nefecon\u2019s design for terminal ileum absorption, and hence assumed minimal systemic exposure, this case demonstrates clinically significant adverse effects and adrenal suppression. These findings underscore the need for careful monitoring and patient education when initiating and tapering Nefecon in IgAN management.<\/jats:p>","DOI":"10.1093\/ckj\/sfag037","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T12:50:21Z","timestamp":1772023821000},"source":"Crossref","is-referenced-by-count":2,"title":["A case of adrenal insufficiency after initiation of targeted-release budesonide formulation (Nefecon) in a patient with IgA nephropathy"],"prefix":"10.1093","volume":"19","author":[{"given":"Trisha D","family":"Laxamana","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9952-209X","authenticated-orcid":false,"given":"Fernando C","family":"Fervenza","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J","family":"Glassock","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA Department of Medicine, , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladan","family":"Zand","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"2026042108112650500_bib1","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.2215\/CJN.0000000839","article-title":"Effects of therapies on proteinuria and eGFR in IgA nephropathy: meta-analysis of randomized trials","volume":"20","author":"Kim","year":"2025","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026042108112650500_bib2","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/S0140-6736(23)01554-4","article-title":"NefIgArd Trial Investigators. Efficacy and safety of a targeted-release formulation of budesonide in patients with primary IgA nephropathy (NefIgArd): 2-year results from a randomised phase 3 trial","volume":"402","author":"Lafayette","year":"2023","journal-title":"Lancet"},{"issue":"4 Suppl","key":"2026042108112650500_bib3","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.kint.2025.04.004","article-title":"KDIGO 2025 clinical practice guideline for the management of immunoglobulin a nephropathy (IgAN) and immunoglobulin a vasculitis (IgAV)","volume":"108","author":"Kidney Disease: Improving Global Outcomes IgAN and IgAV Work Group","year":"2025","journal-title":"Kidney Int"},{"key":"2026042108112650500_bib4","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.kint.2022.10.019","article-title":"A disease-modifying approach to the treatment of IgA nephropathy targeting mucosal IgA synthesis and beyond","volume":"103","author":"Coppo","year":"2023","journal-title":"Kidney Int"},{"key":"2026042108112650500_bib5","volume-title":"Tarpeyo (budesonide) [prescribing information]","author":"U.S. Food and Drug Administration","year":"2021"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfag037\/67135944\/sfag037.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/4\/sfag037\/68120792\/sfag037.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/4\/sfag037\/68120792\/sfag037.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:11:33Z","timestamp":1776773493000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfag037\/8499607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":5,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfag037","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,2,26]]},"article-number":"sfag037"}}