Kidney Week

Abstract: TH-PO0482

Six-Month Proteinuria Reduction as a Robust Predictor of Five-Year Kidney Outcomes in IgAN

Session Information

• Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - IgAN
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Kim, Hyun-Jung, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Hyun-Jung Kim, MD, PhD

• Lee, Seunghye, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Seunghye Lee, MD

• Jung, Sehyun, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Sehyun Jung, MD

• Jang, Hani, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Hani Jang, MD, PhD

• Jeon, Hyejin, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Hyejin Jeon, MD

• Kim, Sugyu, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Sugyu Kim

• Lee, Tae won, Gyeongsang National University Changwon Hospital, Changwon, Gyeongsangnam-do, Korea (the Republic of)

Tae won Lee, MD, PhD

• Park, Dong Jun, Gyeongsang National University Changwon Hospital, Changwon, Gyeongsangnam-do, Korea (the Republic of)

Dong Jun Park, MD, PhD

• Chang, Se-Ho, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Se-Ho Chang, MD, PhD

Background

While proteinuria at the time of diagnosis has traditionally been used to predict prognosis in immunoglobulin A nephropathy (IgAN), the clinical significance of dynamic changes in proteinuria shortly after initiating treatment remains to be fully elucidated. We aimed to investigate whether early reduction in proteinuria at 3 and 6 months after kidney biopsy is more closely associated with 5-year renal outcomes than baseline proteinuria.

Methods

We retrospectively analyzed 205 patients with biopsy-proven IgAN. The primary outcome was a 5-year adverse renal outcome, defined as a composite of a ≥ 40% decline in estimated glomerular filtration rate (eGFR) from baseline or progression to renal replacement therapy. The main predictor was the proteinuria reduction rate at 6 months, with 3-month reduction used for sensitivity analysis. Multivariable Cox regression analyses were performed after adjusting for age, sex, baseline eGFR, and baseline proteinuria.

Results

During a mean follow-up of 58.2 months, 37 patients (18.0%) experienced the adverse renal outcome. Baseline proteinuria at the time of biopsy was not significantly associated with 5-year renal outcomes in the multivariable model (P = 0.176). In contrast, 6-month proteinuria reduction was a strong and independent predictor of favorable outcomes (HR, 0.904 per 10% reduction; 95% CI, 0.863–0.946; P < 0.001). Similar results were consistently observed for 3-month proteinuria reduction (HR, 0.930 per 10% reduction; 95% CI, 0.896–0.965; P < 0.001). Kaplan–Meier analysis demonstrated significantly better 5-year renal outcome-free survival in patients achieving a ≥50% reduction in proteinuria at 6 months compared to those with a < 50% reduction (P = 0.005).

Conclusion

Early dynamic reduction in proteinuria, particularly within the first 6 months, is a superior prognostic marker for long-term renal survival in IgAN compared to the absolute level of proteinuria at diagnosis. These findings suggest that short-term proteinuria response may provide more clinically relevant prognostic information than baseline proteinuria in patients with IgAN.