{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:26:40Z","timestamp":1786112800707,"version":"build-2736575974"},"reference-count":15,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Glomerular Dis"],"abstract":"<jats:p>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 3 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 1 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 8 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 activity 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.<\/jats:p>","DOI":"10.1159\/000553107","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T16:01:10Z","timestamp":1782144070000},"page":"279-284","source":"Crossref","is-referenced-by-count":0,"title":["How Late Is Too Late? Successful Use of Targeted-Release Budesonide in IgA Nephropathy with Estimated Glomerular Filtration Rate &lt;30 mL\/min\/1.73 m\n                    <sup>2<\/sup>"],"prefix":"10.1159","volume":"6","author":[{"given":"Abhinav","family":"Sharma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Fatfat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishaan","family":"Batish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Shahrier","family":"Amin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LaTonya J.","family":"Hickson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabeel","family":"Aslam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane A.","family":"Bobart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.25020"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1206793"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfac204"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.06.002"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.05.021"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2025.04.004"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30550-0"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01554-4"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000135"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2025.03.008"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2011050464"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2003.01426.x"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1177\/23247096241260964"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000047060"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2024.12.007"}],"container-title":["Glomerular Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000553107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T16:01:06Z","timestamp":1785945666000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000553107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000553107","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.32747406","asserted-by":"subject"}]},"ISSN":["2673-3633"],"issn-type":[{"value":"2673-3633","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]}}}