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Abstract: PO1585

Severity of Arterial and Arteriolar Sclerosis in IgA Nephropathy and Effects of Renin-Angiotensin System Inhibitors on Its Prognosis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Sugiura, Naoko, 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

IgA nephropathy (IgAN) patients often suffer from renal arterial intimal thickening (AIT) and arteriolar hyaline (AH) however, it is unclear whether these features are associated with a poor prognosis. This study aimed to analyse whether treatment with renin-angiotensin system inhibitors (RASI) improves those patient’s survival.

Methods

This retrospective cohort analysis included total 871 patients with IgAN, grouped according to the absence or presence of AIT (Study 1; AIT0: n=415, AIT1: n=268) or AH (Study 2; AH0: n=405, AH1: n=354). The clinical, laboratory, and histological backgrounds of the patients were analyzed along with their 20-year renal prognosis. In the AIT1 and AH1 groups, the effect of renin-angiotensin system inhibitors (RASI) on renal prognosis after making adjustments for the background was analyzed and risk factors for progression were also analyzed.

Results

IgAN patients with AIT1 or AH1 had significantly higher age, blood pressure, body mass index, total cholesterol, uric acid levels, and proteinuria than patients with AIT0 or AH0. They also had more marked histologic findings, decreased renal function, and lower survival rates (AIT: 62.2% vs. 83.4%, p<0.0001; AH: 63.5% vs. 85.4%, p<0.0001). Multivariate Cox regression analysis considering with clinical and histological findings and treatments revealed AIT and AH as an independent factor for disease progression (AIT1: hazard ratio (HR), 1.98, p=0.017; AH1: HR, 2.12, p=0.014). The renal survival rate was significantly higher in IgAN patients with AIT1 or AH1who were treated with RASI than in those who were not treated with RASI after background adjustments (AIT1: 71.1% vs. 50.4%, p=0.023; AH1: 76.4% vs. 39.5%, p=0.006). RASI was found to be an independent factor in the prevention of progression, by multivariate Cox regression analyses (AIT1: HR, 0.40, p=0.014; AH1: HR, 0.42, p=0.007).

Conclusion

AIT and AH are associated with serious clinical, laboratory and histological findings and a poor prognosis. RASI was found to improve renal prognosis of those patients.