Abstract: TH-PO0504
Urinary N-Glycans Predict Long-Term 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
- Kimura, Yuriko, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Mise, Koki, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Onishi, Yasuhiro, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Tanabe, Katsuyuki, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Uchida, Haruhito A., Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Wada, Jun, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
Background
We previously reported that urinary N-glycans recognized by two lectins, Erythrina cristagalli (ECA) and Narcissus pseudonarcissus (NPA), were associated with composite renal outcomes in patients with IgA nephropathy (IgAN) during a 3-year follow-up (Sci Rep. 2021;11(1):3394). However, their associations with long-term renal prognosis remain unclear.
Methods
A total of 154 patients with biopsy-proven isolated IgAN who underwent renal biopsy at Okayama University Hospital between December 2010 and August 2017 were enrolled. Urinary Cy3-labeled glycoproteins binding to 45 lectins were measured at baseline. The composite outcome was ≥ 30% decline in eGFR, dialysis initiation, or all-cause death. Associations between urinary glycans and renal outcomes were evaluated using Cox proportional hazards models.
Results
During a median follow-up of 6.2 years (IQR: 2.7-10.2), 35 patients reached the outcome. The mean age was 41.8 ± 16.2 years, and 69.5% of patients received glucocorticoid (GC) therapy. Mean baseline eGFR was 71.1 ± 26.0 ml/min/1.73 m2, and 24-h urinary protein excretion was <0.5, 0.5-3.5, and ≥3.5 g/day in 42%, 50%, and 8% of patients, respectively. Pathologically, chronic lesions including interstitial fibrosis and tubular atrophy (IFTA) were severer in patients without GC therapy. After adjustment for GC therapy and known indicators of renal prognosis of IgAN, including baseline eGFR and proteinuria categories, urinary glycans binding to ECA and Griffonia simplicifolia (GSL-II) were significantly associated with the primary outcome (+1SD for log[glycan signal intensity], HR for ECA: 1.85 [95% CI: 1.05-3.24], and HR for GSL-II: 2.08 [1.16-3.75], respectively). These associations remained significant in patients without GC therapy (HR for ECA: 2.41 [95% CI: 1.04-5.58] and HR for GSL-II: 3.33 [1.04-10.65], respectively), whereas not in the group with GC therapy (HR for ECA: 1.36 [95% CI: 0.75-2.46] and HR for GSL-II: 1.54 [0.79-3.02], respectively). The glycan Galb1-4GlcNAc and fully agalactosylated N-glycans bind to ECA, whereas GlcNAc and agalactosylated tri/tetra-antennary glycans bind to GSL-II. Neither lectin binds fully galactosylated or sialylated N-type glycans, consistent with IgAN pathogenesis.
Conclusion
Urinary N-glycans recognized by ECA and GSL-II might be useful predictors of the renal prognosis in IgAN patients, especially with advanced chronic lesions leading to the follow-up without GC therapy.
Funding
- Government Support – Non-U.S.