Long-term renal outcomes of IgA nephropathy presenting with different levels of proteinuria
Long-term renal outcomes of IgA nephropathy presenting with different levels of proteinuria
复制标题
表现为不同水平蛋白尿的 IgA 肾病的长期肾脏结局。
DOI：
10.5414/cn110192
复制
发表时间：
2020-12-01
影响因子：
1.1
通讯作者：
Yu, Xueqing
中科院分区：
文献类型：
--
作者：
Ai, Zhen;Zhou, Qian;Yu, Xueqing
目标管理系统
蛋白尿是 IgA 肾病 (IgAN) 的一个重要预后因素。然而，蛋白尿导致肾脏疾病进展的风险阈值仍存在争议。本研究旨在评估不同水平蛋白尿对中国 IgAN 患者肾脏结局的风险。
材料和方法
招募经活检证实的原发性 IgAN 患者，并根据蛋白尿水平分为四组：≤ 0.30 g/d、0.31 - 0.50 g/d、0.51 - 1.00 g/d 和 > 1.00 g/d。主要结局包括基线血清肌酐 (Scr) 翻倍和终末期肾病（ESRD，定义为 eGFR < 15 mL/min/1.73m2，开始透析或移植）。
结果
共有 921 名 IgAN 患者参与了这项研究。在中位随访时间为 48 (34 - 62) 个月期间，蛋白尿患者基线 Scr 加倍的风险较高，为 0.31 - 0.50 g/d (HR = 2.87, p = 0.04)、0.51 - 1.00 g/d (HR = 4.26, p = 0.002) 和> 1.00 g/d (HR = 14.56, p < 0.001)，而在未经调整的蛋白尿 0.51 - 1.00 g/d (HR = 3.00, p = 0.02) 和 > 1.00 g/d (HR = 13.03, p < 0.001) 的患者中观察到 ESRD 风险增加考克斯回归模型。调整潜在混杂因素后，蛋白尿 0.31 - 0.50 g/d (HR = 3.70，p = 0.04)、0.51 - 1.00 g/d (HR = 3.67，p = 0.02) 和 > 1.00 g/d (HR = 8.20，p < 0.001) 仍然与Scr 加倍的风险较高，而只有蛋白尿 > 1.00 g/d (HR = 6.04，p = 0.001) 的患者出现 ESRD 的风险显着增加。
结论
蛋白尿水平 > 0.30 g/d 的患者基线 Scr 加倍的风险较高，这表明有必要对蛋白尿极少的患者进行早期干预。
AIMS
Proteinuria is a strong prognostic factor in IgA nephropathy (IgAN). However, the risk threshold of proteinuria for kidney disease progression remains in debate. This study aimed to evaluate the risk of different levels of proteinuria on renal outcomes in Chinese patients with IgAN.
MATERIALS AND METHODS
Patients with biopsy-proven primary IgAN were recruited and divided into four groups based on their proteinuria levels: ≤ 0.30 g/d, 0.31 - 0.50 g/d, 0.51 - 1.00 g/d, and > 1.00 g/d. The primary outcomes were composed by doubling of baseline serum creatinine (Scr) and end-stage renal disease (ESRD, defined as eGFR < 15 mL/min/1.73m2, initiation of dialysis or transplantation).
RESULTS
A total of 921 IgAN patients were enrolled in this study. During a median follow-up duration of 48 (34 - 62) months, higher risks of doubling of baseline Scr developed in patients with proteinuria 0.31 - 0.50 g/d (HR = 2.87, p = 0.04), 0.51 - 1.00 g/d (HR = 4.26, p = 0.002), and > 1.00 g/d (HR = 14.56, p < 0.001), while increased risks for ESRD were observed in patients with proteinuria 0.51 - 1.00 g/d (HR = 3.00, p = 0.02) and > 1.00 g/d (HR = 13.03, p < 0.001) in unadjusted Cox regression models. After adjusted for potential confounders, proteinuria 0.31 - 0.50 g/d (HR = 3.70, p = 0.04), 0.51 - 1.00 g/d (HR = 3.67, p = 0.02), and > 1.00 g/d (HR = 8.20, p < 0.001) remained to be significantly associated with higher risks of doubling of Scr, while only those with proteinuria > 1.00 g/d (HR = 6.04, p = 0.001) exhibited a markedly increased risk of ESRD.
CONCLUSION
Patients with proteinuria levels > 0.30 g/d already have a higher risk of doubling of baseline Scr, suggesting the necessity of early intervention in patients presenting with minimal proteinuria.