Abstract: TH-PO093
The GRACE IgA Nephropathy in Indians (IgANI) Study
Session Information
- Clinical/Diagnostic Renal Pathology and Lab Medicine - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine
Authors
- Alexander, Suceena, Christian Medical College, Vellore, Tamil NADU, India
- Theophilus-Sunder, Vijayakumar, Christian Medical College, Vellore, Tamil NADU, India
- David, Vinoi George, Christian Medical College, Vellore, Tamil NADU, India
- Mohapatra, Anjali, Christian Medical College, Vellore, Tamil NADU, India
- Valson, Anna T., Christian Medical College, Vellore, Tamil NADU, India
- Kakde, Shailesh Tulshidas, Christian Medical College, Vellore, Tamil NADU, India
- Pusey, Charles D., Imperial College London, London, United Kingdom
- Daha, Mohamed R., Leiden University Medical Center, Leiden, Netherlands
- Barratt, Jonathan, University of Leicester, Leicester, United Kingdom
- Feehally, John, University of Leicester, Leicester, United Kingdom
- John, George, Royal Brisbane and Womens Hospital, Brisbane, New South Wales, Australia
- Varughese, Santosh, Christian Medical College, Vellore, Tamil NADU, India
Background
In India, about 30-40% IgAN patients present with nephrotic syndrome and renal dysfunction and progress rapidly.
Methods
Prospective longitudinal single center cohort.
Inclusion Criteria:
Age ≥18 years.
Renal biopsy proven primary IgA nephropathy.
CKD EPI eGFR > 10ml/min/1.73m2.
Treatment naïve.
Definitions:
Rapid Progresser (RP): IgAN patients with ≥5ml/min/1.73m2/year fall in glomerular filtration rate (GFR) as estimated by the CKD EPI equation.
Slow/Non Progresser (S/NP): IgAN patients with <5ml/min/1.73m2/year fall in CKD EPI eGFR.
End of study outcome (EOS): Composite end-point of 50% decline in eGFR with eGFR <10ml/min/1.73m2, RRT or death whichever occurs earlier.
Results
165 patients were included. Refer table for baseline parameters. Average in-center follow-up duration of 135 patients was 5.0 ± 4.4 months. There were 82/135 (60.7%) S/NPs and 53/135 (39.3%) RPs at follow-up. EOS outcome was reached in 1.2% of S/NPs vs. 30.2% of RPs. The significant predictors of EOS outcome for the cohort by Cox Regression analysis are given in the figure.
Conclusion
28% of patients were RPs at follow-up. Higher hsCRP levels were protective whereas female gender, Hb <10g/L and MEST T2 score were significant risk factors for EOS outcome.
Baseline Characteristics
| Parameters | Total, n=165 | Slow/non-progressors, n=82/135 | Rapid progressors, n=53/135 |
| Gender M: F | 121: 44 | 67:15 | 35:18 |
| Age (years) mean ± SD | 36.9 ± 10 | 36.3 ± 9.3 | 34 ± 11.1 |
| Serum albumin (g/dL) mean ± SD | 4.0 ± 0.5 | 4.0 ± 0.5 | 4.5 ± 0.4 |
| Proteinuria ≥3g/day, n (%) | 56 (34.1%) | 24/81 (29.6) | 25/53 (47.2) |
| Serum hsCRP <0.99 mg/dL n (%) 1-9.99 mg/dL n (%) 10 mg/dL n (%) | 22/157 (14) 85 (54.1) 50 (31.8) | 11/81 (13.6) 37/81 (45.7) 33/81 (40.7) | 7/53 (13.2) 31/53 (58.5) 15/53 (28.3) |
| CKD EPI creatinine eGFR (ml/min/1.73m2) mean ± SD | 46.6 ± 30.9 | 56.9 ± 27.8 | 82 ± 34.4 |
| Percent crescentic glomeruli mean ± SD | 0.7 ± 3.7 | 0.7 ± 3.7 | 0 |
| MEST S1 n (%) | 123/154 (79.9) | 19/27 (70.4) | 65/80 (81.3) |
| MEST T2 n (%) | 76/155 (49) | 38/80 (47.5) | 29/48 (60.4) |
135 patients had in-center follow-up till date
Cox Regression Curves
Funding
- Government Support - Non-U.S.