Abstract: TH-PO1016
Diagnosis, Treatment, and Outcome of IgA Nephropathy with vs. Without Comorbid Diabetes Mellitus
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
- 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.
| Characteristics | IgAN without DM N=53 Median (IQR) | IgAN with DM N=25 Medican (IQR) | p-value |
| Age, years | 40 (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/1.73m2 | 47 (32, 79) | 47 (24, 64) | 0.4 |
| Baseline urine protein:creatinine, g/g | 2 (1.0, 4.0) | 2 (1.4, 6.0) | 0.1 |
| Baseline body mass index, kg/m2 | 28 (22, 32) | 43 (29, 49) | 0.003 |
| Duration of follow-up, months from biopsy | 39 (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/g | 0.7 (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