Abstract: SA-PO273

The Effects of Renin Angiotensin Aldosterone System Inhibitors (RASI) for IgA Nephropathy (IgAN) Patients with Oxford T1/2 Lesions

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Kamiyama, Takahiro, Tokyo Women''s Medical University, Tokyo-to, Japan
  • Moriyama, Takahito, Tokyo Women's Medical University, Tokyo, Japan
  • Nakano, Marie, Tokyo Women's Medical University Hospital, Tokyo, Japan
  • Karasawa, Kazunori, Department medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
  • Nitta, Kosaku, Tokyo Women's Medical University, Tokyo, Japan
Background

IgAN has been recognized as a not a benign disease and 40% of patients developed to end-stage renal disease (ESRD) within 20 years. Severe histological findings have been reported as risk factors of IgAN. Global sclerosis was one of the risk factors, and in Oxford classification, it was recognized as same as tubulointerstitial (T) lesions according to their correlation. Therefore, in IgAN patients with T lesions, the glomerular hyperfiltration and hypertension were seemed to be occurred, and, RASI might be effective to decrease them and prevent progressing to ESRD. However, these beneficial effects of RASI on patients with T lesions haven't been previously reported.

Methods

In this retrospective cohort study, from 697 biopsy proven IgAN patients in our institution between 1990 and 2010, we divided 87 patients withT1/2 lesions into two groups: RASI group (n=47, treated with RASI) and control groups treated with antiplatelet agents (APA group, n=40). We analyzed the clinical and histological background, the serial change of blood pressure and the amount of urinary protein (U-Prot), progression to ESRD, and the risk factors for progression after adjusting by propensity score matching.

Results

After adjusting clinical findings with significant difference at base line, 22 cases from each group were selected, and clinical and histological characteristics were similar between both groups The mean eGFR 58.5 vs.57.1 ml/min/1.73^2, and median U-Prot 1.14 vs. 0.95 g/day in RASI and APA group, respectively. Serial change of blood pressure during two years after treatment was significantly decreased in RASI group (p=0.0029), but not in APA group. The serial change of U-prot was tended to decrease in RASI group, though it was not significant (1.14 to 0.47 g/gCre), but it was similar in APA group (0.95 to 0.85 g/gCre). The renal survival rate in Kaplan Meyer Analysis was 60%/20 years in RASI group and 20%/20 years in APA group (p=0.0119). In multivariate Cox regression analysis, RASI was an independent factor to prevent from progression to ESRD (HR 5.91, 95% CI: 1.53-22.8).

Conclusion

RASI has shown significant beneficial effect on histologically advanced IgAN patients with Oxford T1/2 lesions, who were suspected to have glomerular hypertension and hyperfiltration according to severe global sclerosis.