#2644 Clinical impact of proteinuria and hematuria remission criteria in IgA nephropathy patients defined by the Japanese Society of Nephrology

Abstract

Abstract Background and Aims IgA nephropathy (IgAN) is one of the most common glomerulonephritis worldwide, especially in the Pacific Rim and Mediterranean countries. Hematuria is almost inevitable clinical findings and massive proteinuria is well established risk factor in IgAN. However, a few studies reported hematuria and proteinuria remission in IgAN, and their definition varies in clinical studies. The Japanese Society of Nephrology (JSN) defined new criteria for hematuria and proteinuria remission and relapse for IgAN patients. The objective of the present study was to analyze the utility of JSN criteria to predict renal prognosis among IgAN patients after immunosuppressive treatment. Method One hundred IgAN patients were recruited between 2003 and 2014 at Nagoya University Hospital and followed up until December 2017. According to JSN criteria, hematuria remission (HR) and proteinuria remission (PR) are defined as < 5 RBC/HPF, and < 0.3 g/g Cr, in three consecutive urine exams over six months of observation, respectively. Clinical remission (CR) is defined as both HR and PR in 3 consecutive urinalysis over six months. HR, PR and CR were analysed with 30% eGFR decline as a renal outcome. Results Baseline proteinuria, serum creatinine, and eGFR were 1.3g/day, 0.8 mg/dL, and 80 mL/min/1.73 m2. The mean age was 34.7 ± 12.5 years old, and 61% of the study population was female. Seventy-two percent of patients received intensive methylprednisolone pulse therapy (mPSL), and the incidence of HR, PR and CR were 76, 50 and 46%, 50%, respectively. Kaplan-Meier curves analyses showed a significant difference between HR and non-HR, PR and non-PR, and CR and non-CR groups (Fig.). In univariate analyses, hypertension, eGFR, HR, PR, CR, and T-score in the Oxford classification of IgAN were significantly associated with renal outcome. In multivariate Model-A, HR, and PR were significant factors for renal outcome after adjusting with sex, hypertension, eGFR and T-score. While in multivariate model-B, CR was also significantly associated with renal outcome after adjustment (Table). However, 36% and 46% of patients demonstrated hematuria and proteinuria relapses after remission. Conclusion JSN novel criteria for HR and PR predict renal outcomes in IgAN patients. Further studies are required to verify their clinical utility of JSN criteria in a larger sample size with different ethnicities.