Abstract: TH-PO1014
Examination of the Factor Related to the Prognosis in IgA Nephropathy Patients with Mild Proteinuria at Diagnosis
Session Information
- Glomerular Diseases: Minimal Change Disease, FSGS, IgAN
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Shirai, Sayuri, St. Marianna University School of Medicine, Kawasaki, Japan
- Yasuda, Takashi, Hospital, Tokyo, Japan
- Matsunobu, Hanako, Self-Defense Forces Central Hospital, Tokyo, Japan
- Kumagai, Hiroo, National Defense Medical College,, Tokorozawa, SAITAMA, Japan
- Ichikawa, Daisuke, St Marianna University of Medical School, Yokohama City, KANAGAWA, Japan
- Shibagaki, Yugo, St Marianna University Hospital, Kawasaki, Japan
- Yasuda, Yoshinari, Nagoya University Graduate School of Medicine, Nagoya, Aichi-ken, Japan, Nagoya, Japan
- Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Kawamura, Tetsuya, Jikei University School of Medicine, Tokyo, Japan
- Suzuki, Yusuke, Juntendo University School of Medicine, Tokyo, Japan
Background
The prognosis for patients with IgA nephropathy (IgAN) with urinary protein <0.5 g / day has been considered good, but there are few reports on factors that affect their renal prognosis.
Methods
A total of 1171 adult patients who was diagnosed with IgAN by the first renal biopsy between 2002 and 2004 were registered in the Nationwide Retrospective Cohort Study in IgAN from 42 institutes all over Japan. In 394 patients with a baseline urinary protein (U-Prot) <0.5 g/day having sufficient data and observation period, a long-term renal outcome was analyzed. The primary outcome was an increase of more than 50 % in serum creatinine levels from the baseline.
Results
Primary outcome was observed in 12 patients (3.0 %). Of 394 patients, 330 had eGFR ≧60 ml/min and U-Prot <0.5 g/day [Clinical Grade (CG) Ia] and 64 had eGFR <60 ml/min and U-Prot <0.5 g/day (CG Ib). There was a significant difference in the incidence of renal outcome between the two groups (log-rank test p<0.001 between CG Ia and CG Ib). Hazard ratio (HR) in CG Ib vs. CG Ia was 9.67 (95 % CI: 2.90–32.23). On univariate analysis using Cox proportional hazards analysis, high uric acid, male, and no remission up to 2 years after renal biopsy were the significant risk factors, whereas tonsillectomy or corticosteroid therapy did not improve the renal outcome. In multivariate analysis using those significant factors, only eGFR <60 ml/min was selected as a significant independent factor (HR in CG Ib vs. CG Ia was 37.1 (95 % CI: 3.11–444.0).
Conclusion
In the present study, we confirmed that eGFR <60 ml/min was an independent risk factor in IgA nephropathy patients with mild proteinuria (<0.5 g/day). It is necessary to verify these results in the ongoing prospective study with a large cohort in the future.