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First‐year GFR slope and long‐term renal outcome in IgA nephropathy
Author(s) -
Lee Kyungho,
Shin Jungho,
Park Jeeeun,
Hwang Subin,
Jang Hye Ryoun,
Huh Wooseong,
Kwon Ghee Young,
Kim YoonGoo,
Oh Ha Young,
Lee Jung Eun,
Kim Dae Joong
Publication year - 2018
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12936
Subject(s) - renal function , medicine , urology , creatinine , proteinuria , quartile , nephropathy , gastroenterology , endocrinology , kidney , confidence interval , diabetes mellitus
Background IgA nephropathy (Ig AN ) is the most frequent primary glomerular disease and the leading cause of end‐stage renal disease. We investigated clinicopathologic predictors of renal survival in patients with Ig AN with a focus on glomerular filtration rate ( GFR ) decline slope. Materials and methods We screened all patients with primary Ig AN between 1995 and 2012. Renal progression was defined as doubling of serum creatinine. Using serial serum creatinine levels during the first‐year, we calculated the GFR decline slopes. Further, we defined patients in the steepest GFR slope quartile as rapid decliners and those in the second steepest GFR slope quartile as slow decliners. Others were defined as nondecliners. Results Of 214 participants, baseline GFR was 81 (62, 100) mL/min/1.73 m 2 , which was not different among the 3 groups. Rapid decliners and slow decliners had higher levels of urinary protein/creatinine ratio (0.88, 0.89 and 0.58 g/ gC r, respectively, P < .001). Five‐year renal survival was 76% in rapid decliners, 91% in slow decliners and 100% in nondecliners ( P < .001, rapid or slow decliners vs nondecliners). After adjustment for clinicopathologic variables, slow decliners were associated with an 8.8‐fold higher risk of progression ( P = .011), and rapid decliners were associated with a 10.2‐fold increased risk of progression ( P = .007) compared with nondecliners. Conclusions First‐year GFR slope was associated with increased risk of renal progression, independent of proteinuria and histologic findings. Further studies are needed to investigate whether early GFR change can identify high‐risk patients who benefit from immunosuppressive treatment in Ig AN .