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Kidney Week

Abstract: TH-PO1016

Diagnosis, Treatment, and Outcome of IgA Nephropathy with vs. Without Comorbid Diabetes Mellitus

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Saha, Manish K., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Poulton, Caroline J., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Hu, Yichun, UNC Kidney Center & Divisions of Nephrology & Hypertension, Chapel Hill, North Carolina, United States
  • Falk, Ronald J., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Hogan, Susan L., University of North Carolina, Chapel Hill, North Carolina, United States
  • Mottl, Amy K., University of North Carolina, Chapel Hill, North Carolina, United States
Background

The U.S. pandemic of diabetes mellitus (DM) has greatly complicated the diagnosis and clinical care of patients with glomerular diseases, such as IgA nephropathy (IgAN), the most common glomerular disease in the world. Our aim was to study the influence of DM on the diagnosis, treatment and clinical outcome of patients with IgAN.

Methods

We conducted a retrospective chart review of patients from the Glomerular Disease Collaborative Network (GDCN) inception cohort of adults with a pathologic diagnosis of IgAN on native biopsies performed between 1/1/1999 - 6/30/2018. GFR was estimated based using the CKD-EPISCR equation obtained at the time of kidney biopsy. Urine protein:creatinine ratio was measured from a random urine collection.

Results

There was only one patient with type 1 DM and only two patients had histologic diabetic glomerulosclerosis. Indications for kidney biopsy and baseline blood pressure was similar for the two groups. Detailed baseline characteristics, immunosuppressive treatments and clinical outcomes are displayed in Table 1.

Conclusion

Patients with IgAN with versus without diabetes do not differ in the severity of proteinuria or eGFR at the time of diagnosis. Despite a reduced usage of steroids among patients with IgAN and diabetes, follow-up proteinuria and rate of eGFR decline do not differ from those with IgAN without comorbid diabetes. Larger, long term studies are required to fully understand the relationship between DM and IgAN.

Sociodemographic and clinical characteristics of Ig A nephropathy patients with versus without comorbid diabetes.
CharacteristicsIgAN without DM
N=53
Median (IQR)
IgAN with DM
N=25
Medican (IQR)
p-value
Age, years40 (31, 51)55 (46, 59)0.0007
Female, N (%)20 (37.7)8 (32.0)0.8
NonHispanic white race, N (%)40 (78.4)20.0 (83.3)0.8
Baseline eGFR, mL/min/1.73m247 (32, 79)47 (24, 64)0.4
Baseline urine protein:creatinine, g/g2 (1.0, 4.0)2 (1.4, 6.0)0.1
Baseline body mass index, kg/m228 (22, 32)43 (29, 49)0.003
Duration of follow-up, months from biopsy39 (16, 81)37 (20, 58)0.5
Immunosuppressives, N (%)
Steroids
Cyclophosphamide
Mycophenolate Mofetil
37 (69.8)
18 (33.9)
9 (16.9)
11 (44.0)
4 (16.0)
2 (8.0)
0.04
0.1
0.4
Rate of eGFR decline, mL/min/1.73m2 per year-0.5 (-5.8, 5.2)0.0 (-7.2, 5.6)0.8
Last available urine protein:creatinine, g/g0.7 (0.2, 2.0)0.4 (0.1, 0.8)0.4
End-stage kidney disease, N (%)9 (17.0)6 (24.0)0.5
Death, N (%)5 (9.4)6 (24)1.0

*p-values calculated by Fisher’s exact test for continuous and Wilcoxon two sample test for categorical variables.

Funding

  • Clinical Revenue Support