Inpatient physical therapy and changes in physical function in an older patient with acute-phase IgA nephropathy: a case report with literature review

Abstract Background The effects and safety of acute-phase rehabilitation in older patients with immunoglobulin A (IgA) nephropathy undergoing steroid therapy remain unclear. In particular, evidence on the impact of steroid therapy on physical function is limited. This case study aimed to examine the effects of acute-phase rehabilitation on physical function over time in an older patient with IgA nephropathy. Case presentation The patient was an 89-year-old woman diagnosed with IgA nephropathy following renal biopsy. Prednisolone (30 mg) was initiated on day 21 of hospitalization. Moderate-intensity exercise therapy (40 min, five times per week) was started, and included resistance training, balance training, aerobic training, and activities of daily living training. Grip strength increased from 14.8 to 17.7 kg by day 22 but decreased to 15.4 kg by day 49. The Short Physical Performance Battery score improved from 9 to 10 points by day 22 but dropped to 8 points thereafter, with a marked decline in chair stand performance. Gait speed and tandem standing remained stable. The 6-min walk distance improved steadily from 310 to 390 m. Renal function remained stable, with estimated glomerular filtration rate changing from 40.9 to 35.6 mL/min/1.73 m 2 and urine protein/creatinine ratio improving from 6.5 to 1.6 g/gCr. Conclusions Moderate-intensity exercise therapy may be safely applied in older patients with acute IgA nephropathy undergoing steroid therapy and may help maintain exercise tolerance. However, early decline in lower limb function suggests the importance of comprehensive support from the early phase.