Abstract
Serum albumin is the major intravascular antioxidant. Though oxidative stress plays an important role in the pathophysiology of Immunoglobulin A nephropathy (IgAN), the association between serum albumin and the progression of IgAN is not entirely understood. This retrospective cohort study of 1,352 participants with biopsy-proven IgAN determined the associations between serum albumin level and the incidence of end-stage renal disease (ESRD) using a Cox proportional hazards model. Patients were divided into three groups by tertiles of serum albumin level: Low, Middle, and High group (≤3.9 g/dL, 4.0–4.3 g/dL, ≥4.4 g/dL, respectively). During the median 5.1-year follow-up period, 152 patients (11.2%) developed ESRD. Participants in the Low group had a 1.88-fold increased risk for ESRD compared with those in the High group after adjustment for clinical parameters, including urinary protein excretion, and pathological parameters (Oxford classification). We also experimentally proved the antioxidant capacity of albumin on mesangial cells. The intracellular reactive oxygen species and mitochondrial injury, induced by hydrogen peroxide were significantly attenuated in albumin-pretreated mouse mesangial cells and human kidney cells compared with γ-globulin-pretreated cells. Low serum albumin level is an independent risk factor for ESRD in patients with IgAN. The mechanism could be explained by the antioxidant capacity of serum albumin.
Highlights
Immunoglobulin A nephropathy (IgAN) is the most common type of idiopathic glomerulonephritis throughout the world [1,2]
We previously reported that low serum bilirubin, which had been recognized as an endogenous antioxidant molecule, was associated with high risk of developing end-stage renal disease (ESRD) in patients with IgAN [18]
We clearly revealed the relationship between low serum albumin and either the incidence of ESRD or the doubling of serum creatinine from baseline in patients with IgAN
Summary
Immunoglobulin A nephropathy (IgAN) is the most common type of idiopathic glomerulonephritis throughout the world [1,2]. Despite the identification of these risk factors, the long-term renal prognosis of IgAN is still poor [6,7,8]. It has been reported that the renal survival rate at 20 years was almost 60–70% in IgA nephropathy patients [8,9]. To achieve better renal prognosis, further investigation to identify relevant risk factors for renal survival is important in patients with IgAN. Serum albumin is the most abundant intravascular protein and is widely used for routine clinical examination [10]. It has various physiological functions such as being a key molecule in the regulation of osmotic pressure, a transporter of drugs, fatty acids, and metals [11]. Serum albumin is the major intravascular antioxidant, which has more than 70% of free radical-trapping activity in serum [12]
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