Effect of Hydroxychloroquine on Proteinuria and Inflammatory Markers in Chronic Glomerulopathy: A Randomized Controlled Trial (HCQ-CGN Trial)

Background: Hydroxychloroquine (HCQ) is widely used for its immunomodulatory properties. Chronic glomerulopathy (CGN) involves persistent kidney damage due to inflammation, often accompanied by proteinuria. HCQ has potential as an adjunctive treatment for CGN with persistent proteinuria. This study aimed to evaluate the efficacy of HCQ in reducing proteinuria and inflammatory markers when used alongside standard treatment in patients with CGN. Methods: A randomized, placebo-controlled trial enrolled 43 CGN patients with a urine protein to creatinine ratio of ≥ 0.5 g/g and an eGFR > 20 mL/min/1.73 m2. Patients were randomly assigned to receive HCQ (N=21) or placebo (N=22) for 4 months. Changes in UPCR, hsCRP, IL-6, and eGFR were measured pre- and post-treatment. Results: After 4 months, the HCQ group showed a proteinuria reduction of -27.85% [-55.10, -15.47], significantly greater than the control, resulting in a between-group beta change of -118.55% [-208.07, -29.03; p = 0.009*]. The HCQ group also achieved a more significant 30% proteinuria decrease. Additionally, the percentage change reduction in serum IL-6 and hsCRP was significantly higher in the HCQ group. No differences were observed in eGFR, and no serious adverse events occurred. Conclusion: HCQ adjunct therapy significantly reduced proteinuria and inflammatory markers in CGN patients without affecting kidney function or causing serious adverse events, suggesting an anti-inflammatory role in reducing proteinuria.Proteinuria reduction after 4 months of the studyPercent with >30% reduction in proteinuria excretion.