Abstract: TH-PO093

The GRACE IgA Nephropathy in Indians (IgANI) Study

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Alexander, Suceena, Christian Medical College, Vellore, Tamil NADU, India
  • 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
  • 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
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
ParametersTotal, n=165Slow/non-progressors, n=82/135Rapid progressors, n=53/135
Gender M: F121: 4467:1535:18
Age (years) mean ± SD36.9 ± 1036.3 ± 9.334 ± 11.1
Serum albumin (g/dL) mean ± SD4.0 ± 0.54.0 ± 0.54.5 ± 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 ± SD46.6 ± 30.956.9 ± 27.882 ± 34.4
Percent crescentic glomeruli
mean ± SD
0.7 ± 3.70.7 ± 3.70
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.