Abstract
BackgroundInterstitial fibrosis/tubular atrophy (T) score is a known determinant of the progression of immunoglobulin A nephropathy (IgAN). Strong evidence indicates that the components of the coagulation system closely linked with fibrotic events have been highlighted in the kidney. However, whether the coagulation system can affect the renal outcome of IgAN remains unclear. Herein, we investigated the association of coagulation parameters and pathological phenotype of IgAN and their combined effects on the deterioration of renal function.MethodsThis retrospective study included N = 291 patients with biopsy-proven IgAN from May 2009 to April 2013 in the Second Xiangya Hospital. Clinical data, pathological features were collected, and the associations of coagulation parameters at biopsy, T score, and renal outcome were evaluated. T score indicated the degree of tubular atrophy or interstitial fibrosis. The renal outcome was defined as an end-stage renal disease (ESRD) or an irreversible 50% estimated glomerular filtration rate (eGFR) reduction.ResultsShorter prothrombin time (PT) and the activated partial thromboplastin time (APTT) were significantly associated with T (both p < 0.001). PT (< 11.15 s) or APTT (< 29.65 s) had worse cumulative survival rate (p = 0.008, p = 0.027 respectively) and were significantly but not independently associated with a higher risk of renal outcome (p = 0.012, p = 0.032 respectively). In the combined analyses of PT, APTT, and T lesions, the odd ratios for the outcome were significantly higher in the presence of T with PT (< 11.15 s) or APTT (< 29.65 s).ConclusionShorter PT and APTT are associated with an increased incidence of the T lesion and are additional factors that portend a poorer prognosis in IgAN. Monitoring coagulation function might be important when assessing the risk of progression. Additional studies exploring the molecular mechanism between coagulation and IgAN pathology are needed.
Highlights
Interstitial fibrosis/tubular atrophy (T) score is a known determinant of the progression of immunoglobulin A nephropathy (IgAN)
Are coagulation parameters at the time of renal biopsy associated with T score? Second, how much do the coagulation parameters affect the renal outcome? To investigate this, we identified a cohort of patients with biopsy-proven IgAN and collected their clinical and laboratory parameters
The exclusion criteria included (1) a biopsy specimen containing less than eight glomeruli, (2) patients with secondary IgAN, such as Henoch–Schonlein purpura, lupus nephritis, hepatic disease or (3) with end-stage renal disease (ESRD) on admission, (4) patients with missing clinical data at the time of renal biopsy and follow-up data or (5) complicated with other diseases and taking medication that may affect coagulation function
Summary
Subjects Two hundred and ninety-one patients with a biopsybased diagnosis of primary IgAN between May 2009 and April 2013 were recruited at the Second Xiangya Hospital of Central South University. The study was performed with the informed consent of all patients, and the procedure was approved by the Ethics Committee of the Second Xiangya Hospital, Central South University, and is in accordance with the principles of the Declaration of Helsinki. Clinical and pathological measures The following parameters were collected at baseline for each patient: age, gender, systolic blood pressure and mean arterial pressure (SBP and MAP respectively) serum creatinine (Scr), eGFR (modified Modification of Diet in Renal Disease equation) [14], 24 h proteinuria, coagulation parameters including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen degradation products. The analyses were performed using SPSS statistics 22.0 software (SPSS Inc., Chicago, IL, USA) and Graphed Prism 6 (GraphPad Software Inc., San Diego, CA, USA)
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