The predictive value of attenuated proteinuria at 1 year after steroid therapy for renal survival in patients with IgA nephropathy
The predictive value of attenuated proteinuria at 1 year after steroid therapy for renal survival in patients with IgA nephropathy
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DOI：
10.1007/s10157-012-0744-x
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发表时间：
2013-08-01
影响因子：
2.3
通讯作者：
Hosoya, Tatsuo
中科院分区：
文献类型：
--
作者：
Hirano, Keita;Kawamura, Tetsuya;Hosoya, Tatsuo
类固醇治疗后最初获得的尿蛋白排泄（UPE）与IgA肾病（IgAN）的长期肾脏结局之间的关系尚未明确。我们研究了类固醇治疗后1年的阈值UPE，这预示着良好的肾脏生存。我们招募了141名接受6个月类固醇治疗的IgAN患者。终点定义为血清肌酐较基线增加50%。样条模型用于定义预测肾生存的阈值UPE。13名患者（9.2%）在中位随访3.8年时达到终点。当评估终点1年时UPE的相对危险比（HR）时，我们在样条曲线上发现了0.40 g/天的拐点。多变量Cox模型显示，除了UPE消失类别（范围< 0.30 g/天）外，轻度类别（范围0.30-0.39 g/天）相对于重度类别（范围a千分之一日元1.00 g/天）与终点风险降低更多相关[HR 0.02, 95%置信区间（CI） 0.00-0.29]，而中度类别（范围0.40-0.99 g/天）则没有。估计肾小球滤过率< 60 ml/min/1.73 m(2)也是终点的独立预测因子。在Cox模型中，当肾脏生存与病理参数调整时，UPE < 0.40 g/天仍然是一个独立的有利预测因子（HR 0.08, 95% CI 0.01-0.45）。在接受6个月类固醇治疗的IgAN患者中，1年后蛋白尿< 0.4 g/天可能是肾脏预后良好的治疗指标。
The relationship between the urinary protein excretion (UPE) initially achieved after steroid therapy and the long-term renal outcome of IgA nephropathy (IgAN) has not been clarified. We investigated the threshold UPE at 1 year after steroid therapy which predicts a favorable renal survival.We enrolled 141 IgAN patients who received 6 months of steroid therapy. The endpoint was defined as a 50 % increase in serum creatinine from baseline. The spline model was used to define the threshold UPE predicting renal survival.Thirteen patients (9.2 %) reached the endpoint at a median follow-up of 3.8 years. When evaluating the relative hazard ratio (HR) of the UPE at 1 year for the endpoint, we found an inflection point at 0.40 g/day on the spline curve. The multivariate Cox model revealed that, in addition to the Disappeared category of UPE (range < 0.30 g/day), the Mild category (range 0.30-0.39 g/day) was associated with more reduced risk of the endpoint [HR 0.02, 95 % confidence intervals (CI) 0.00-0.29] relative to the Severe category (range a parts per thousand yen1.00 g/day), whereas the Moderate category (range 0.40-0.99 g/day) was not. The estimated glomerular filtration rate < 60 ml/min/1.73 m(2) was also an independent predictor of the endpoint. When renal survival was adjusted with pathological parameters in the Cox model, UPE < 0.40 g/day was still an independent favorable predictor (HR 0.08, 95 % CI 0.01-0.45).In IgAN patients receiving 6 months of steroid therapy, the achievement of proteinuria < 0.4 g/day at 1 year could be a therapeutic indicator for a favorable renal outcome.