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Nefecon Baseline Investigations — ESENeph MCQ

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EasyGlomerulonephritisNefecon Baseline InvestigationsESENeph

A 35-year-old man with IgA nephropathy has an eGFR of 45 and proteinuria of 1.5 g/day. He is on Ramipril 10 mg and Dapagliflozin 10 mg. His nephrologist is considering adding Nefecon. Before starting, what baseline investigations are recommended?

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Correct answer: C — Baseline LFTs (Nefecon can rarely cause adrenal suppression and has minor systemic steroid absorption), BP, bone density consideration (systemic steroid effects), and glucose monitoring – Nefecon has lower systemic bioavailability than conventional steroids but is not zero

Although Nefecon is targeted-release budesonide with ~90% first-pass hepatic metabolism (low systemic bioavailability), approximately 10% reaches the systemic circulation. Baseline assessments should include: LFTs (hepatotoxicity monitoring monthly as with any corticosteroid), glucose (steroid-induced hyperglycaemia), BP, consideration of bone protection (though 9-month course at low systemic exposure is lower risk than conventional steroids), and infection screening (latent TB if risk factors). The lower systemic steroid burden is a key advantage over conventional Prednisolone, but monitoring remains prudent.

Reference: NefIgArd Trial Safety; Nefecon (Kinpeygo) SPC; KDIGO 2025 – IgAN