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Abstract: PO1637

The Beneficial Effects of Renin-Angiotensin System Inhibitors on IgA Nephropathy with Global Sclerosis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kasama, Eri, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Moriyama, Takahito, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Miyabe, Yoei, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Akiyama, Kenichi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Karasawa, Kazunori, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
Background

In IgA nephropathy (IgAN), global sclerosis has been recognized as one of the risk factors for progression, because it induces glomerular hypertension and hyperfiltration in the remained glomeruli. The reno-protective effects of renin-angiotensin system inhibitors (RASI) are considered to decrease glomerular hypertension and hyperfiltration, but their effectiveness in IgAN with global sclerosis has been unknown.

Methods

Of the 871 IgAN patients diagnosed at our institution, we classified them into three grades by the ratio of global sclerosis (G) against whole glomeruli [G0 (n=225): none, G1 (n=455): at least one but <25%, G2 (n=191): ≧25%]. We compared each clinical background and 20-year prognosis. Then, we examined the effect of RASI initiated during follow-up period on the long-term prognosis in patients with G1+G2 and in patients with G2 by Kaplan-Meier analysis and Cox regression analysis. To adjust the background characteristics between patients treated with or without RASI, propensity matching score was performed.

Results

The age, blood pressure, proteinuria, renal function, and histological findings were significantly severer with increasing grade in G0, G1, and G2, and 20-year renal survival rate was 83.5%, 75.0% and 54.4% in patients with G0, G1, and G2, respectively (p<0.001). After propensity matching between patients treated with or without RASI, 366 patients in G1+G2 and 90 patients in G2 were eligible for the evaluation. The 20-year renal survival rate was significantly higher in the patients with RASI than in the patients without RASI (G1+G2: 84.5% vs. 50.9%, p<0.001, G2: 63.8% vs. 33.5%, p=0.037). In multivariate Cox regression analysis considering clinical and histological findings and treatment, RASI was an independent factor to prevent progression in patients with G1+G2 and G2 (G1+G2, hazard ratio: 0.39, 95% confidence interval: 0.25-0.62, p<0.001; G2, hazard ratio: 0.35, 95% confidence interval: 0.19-0.66, p=0.001).

Conclusion

In this study, global sclerosis was associated with severer clinical and histological findings, and poor prognosis. However, RASI initiated during follow up period was found to improve renal prognosis in IgAN with at least one global sclerosis.