{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T09:48:26Z","timestamp":1785750506521,"version":"3.56.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["RD24\/0004\/0014"],"award-info":[{"award-number":["RD24\/0004\/0014"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Secondary IgA nephropathy (IgAN) associated with systemic diseases represents a heterogeneous population in whom renal prognosis and treatment response are poorly defined. Patients with secondary IgAN have been excluded from major trials, and the benefit of adding immunosuppressive therapy to supportive care remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective multicenter cohort study including adults with biopsy-proven rapidly progressive secondary IgAN. Patients received supportive care alone, supportive care plus corticosteroids, or corticosteroids with additional immunosuppression. To address confounding by indication, inverse probability of treatment weighting based on propensity scores was applied, defining treatment escalation as immunosuppressive therapy beyond corticosteroids. Exposure was defined using landmark analyses (primary 30-day; sensitivity 14-day) to reduce immortal time bias. The primary outcome was kidney failure, accounting for death as a competing event. All-cause mortality was assessed using weighted Cox models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety-two patients were included (mean age 61\u00a0\u00b1\u00a016 years; 83% male). Mean estimated glomerular filtration rate at presentation was 17\u00a0\u00b1\u00a010\u00a0ml\/min\/1.73 m\u00b2, and 32% required dialysis. Liver disease was the most frequent underlying condition (51%). Over a median follow-up of 36 months, 32 patients (35%) developed kidney failure and 34 (37%) died. After weighting, baseline covariates were balanced. Treatment escalation was not associated with progression to kidney failure [30-day landmark: subdistribution hazard ratio (SHR) 1.09, 95% confidence interval (CI) 0.35\u20133.38; 14-day landmark: SHR 1.40, 95% CI 0.49\u20134.03] or all-cause mortality [30-day: hazard ratio (HR) 1.20, 95% CI 0.34\u20134.17; 14-day: HR 1.14, 95% CI 0.32\u20134.08]. Renal survival differed by etiology (log-rank P\u00a0=\u00a0.006), with the poorest outcomes in liver disease\u2013associated IgAN. Liver disease (HR 3.16, 95% CI 1.07\u20139.33) and dialysis at presentation (HR 4.20, 95% CI 1.44\u201312.28) independently predicted kidney failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rapidly progressive secondary IgAN carries high renal and patient mortality. After accounting for baseline severity, competing risk, and immortal time bias, treatment escalation was not associated with improved renal or patient survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfag158","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T23:29:47Z","timestamp":1783380587000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of immunosuppressive therapy on renal and patient survival in rapidly progressive secondary IgA nephropathy"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7039-4701","authenticated-orcid":false,"given":"Amir","family":"Shabaka","sequence":"first","affiliation":[{"name":"Nephrology Department, Hospital Universitario La Paz, Instituto de investigaci\u00f3n de la Paz (IdIPAZ) , Madrid ,","place":["Spain"]},{"name":"Nephrology Department, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngel M","family":"Sevillano","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario 12 de Octubre , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Vian","sequence":"additional","affiliation":[{"name":"Nephrology Department, Immunopathology Group, Hospital Universitario Marqu\u00e9s de Valdecilla-IDIVAL , Santander ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Aldana","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario La Paz, Instituto de investigaci\u00f3n de la Paz (IdIPAZ) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antolina","family":"Rodr\u00edguez-Moreno","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Cl\u00ednico San Carlos , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3342-7628","authenticated-orcid":false,"given":"Ana","family":"Huerta","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Puerta de Hierro , Majadahonda ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Hadad","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Virgen de Arrixaca , Murcia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jos\u00e9","family":"Reguera-Carmona","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Nuestra Se\u00f1ora de Candelaria , Santa Cruz de Tenerife ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loreto","family":"Fern\u00e1ndez-Lorente","sequence":"additional","affiliation":[{"name":"Nephrology Department, Cl\u00ednica Universidad de Navarra , Pamplona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaqu\u00edn","family":"Bande","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Central de Asturias , Oviedo ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Gal\u00e1n-Carrillo","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Reina Sof\u00eda , Murcia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milagros","family":"Sierra-Carpio","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital San Pedro , Logro\u00f1o 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