Long term outcome of immunoglobulin A (IgA) nephropathy: A single center experience

被引:17
作者
Mohd, Rozita [1 ]
Kazmin, Nur Ezzaty Mohammad [2 ]
Cader, Rizna Abdul [3 ]
Abd Shukor, Nordashima [4 ]
Wong, Yin Ping [4 ]
Shah, Shamsul Azhar [5 ]
Alfian, Nurwardah [4 ]
机构
[1] Univ Kebangsaan Malaysia, Dept Med, Med Ctr, Kuala Lumpur, Malaysia
[2] Univ Sains Islam Malaysia, Fac Med & Hlth Sci, Nilai, Negeri Sembilan, Malaysia
[3] Pk City Med Ctr, Kuala Lumpur, Malaysia
[4] Univ Kebangsaan Malaysia, Fac Med, Dept Pathol, Kuala Lumpur, Malaysia
[5] Univ Kebangsaan Malaysia, Fac Med, Dept Community Hlth, Kuala Lumpur, Malaysia
来源
PLOS ONE | 2021年 / 16卷 / 04期
关键词
CHRONIC KIDNEY-DISEASE; RISK; PROGRESSION;
D O I
10.1371/journal.pone.0249592
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Introduction IgA nephropathy (IgAN) has a heterogeneous presentation and the progression to end stage renal disease (ESRD) is often influenced by demographics, ethnicity, as well as choice of treatment regimen. In this study, we investigated the long term survival of IgAN patients in our center and the factors affecting it. Methods This study included all biopsy-proven IgAN patients with >= 1year follow-up. Patients with diabetes mellitus at diagnosis and secondary IgAN were excluded. Medical records were reviewed for demographics, clinical presentation, blood pressure, 24-hour urine protein, serum creatinine, renal biopsy and treatment received. The primary outcome was defined as combined event of 50% estimated glomerular filtration rate (eGFR) reduction or ESRD. Results We included 130 (74 females; 56 males) patients of mean age 38.0 +/- 14.0 years and median eGFR of 75.2 (interquartile range (IQR) 49.3-101.4) ml/min/1.73m(2). Eighty-four (64.6%) were hypertensive at presentation, 35 (26.9%) had nephrotic syndrome and 57 (43.8%) had nephrotic range proteinuria (NRP). Median follow-up duration was 7.5 (IQR 4.0-13.0) years. It was noted that 18 (13.8%) developed ESRD and 34 (26.2%) reached the primary outcome. Annual eGFR decline was -2.1 (IQR -5.3 to -0.1) ml/min/1.73m2/year, with median survival of 20 years. Survival rates from the combined event (50% decrease in eGFR or ESRD) at 10, 20 and 30 years were 80%, 53% and 25%, while survival from ESRD were 87%, 73% and 65%, respectively. In the univariate analysis, time-average proteinuria (hazard ratio (HR) = 2.41, 95% CI 1.77-3.30), eGFR <45ml/min/1.73m2 at biopsy (HR = 2.35, 95% CI 1.03-5.32), hypertension (HR = 2.81, 95% CI 1.16-6.80), mean arterial pressure (HR = 1.02, 95% CI 1.01-1.04), tubular atrophy/interstitial fibrosis score (HR = 3.77, 95% CI 1.84-7.73), and cellular/fibrocellular crescent score (HR = 2.44, 95% CI 1.19-5.00) were found to be significant. Whereas only time-average proteinuria (TA-proteinuria) remained as a significant predictor in the multivariate analysis (HR = 2.23, 95% CI 1.57-3.16). Conclusion In our cohort, TA-proteinuria was the most important predictor in the progression of IgAN, irrespective of degree of proteinuria at presentation.
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页数:16
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