Abstract
BackgroundProteinuria is a strong risk factor for renal outcomes in IgA nephropathy. Random urine protein-to-creatinine ratio (PCR), random albumin-to-creatinine ratio (ACR), and 24-h urine protein excretion (24-h UP) have been widely used in clinical practice. However, the measurement which is the best predictor of long-term renal outcomes remains controversial. This study aimed to compare the three measurements in IgA nephropathy.MethodsWe conducted a retrospective study of 766 patients with IgA nephropathy. The associations among baseline ACR, PCR, and 24-h UP with chronic kidney disease (CKD) progression event, defined as 50% estimated glomerular filtration rate (eGFR) decline or end stage kidney disease (ESKD), were tested and compared.ResultsIn this study, ACR, PCR, and 24-h UP showed high correlation (r = 0.671–0.847, P < 0.001). After a median follow-up of 29.88 (14.65–51.65) months, 51 (6.66%) patients reached the CKD progression event. In univariate analysis, ACR performed better in predicting the prognosis of IgA nephropathy, with a higher area under the receiver operating curve (ROC) curve than PCR and 24-h UP. After adjustment for traditional risk factors, ACR was most associated with composite CKD progression event [per log-transformed ACR, hazard ratio (HR): 2.82; 95% (95% CI): 1.31–6.08; P = 0.008].ConclusionsIn IgA nephropathy, ACR, PCR, and 24-h UP had a high correlation. ACR performed better in predicting the prognosis of IgA nephropathy.
Highlights
IgA nephropathy is the most common primary glomerulonephritis worldwide and the main cause of end-stage kidney disease (ESKD) [1]
After adjustment for traditional risk factors, albumin-to-creatinine ratio (ACR) was most associated with composite chronic kidney disease (CKD) progression event [per log-transformed ACR, hazard ratio (HR): 2.82; 95%: 1.31–6.08; P = 0.008]
Three measurements are used for proteinuria evaluation in clinical practice: 24-h urine protein excretion (24-h UP), random urine protein-to-creatinine ratio (PCR), and random albuminto-creatinine ratio (ACR)
Summary
IgA nephropathy is the most common primary glomerulonephritis worldwide and the main cause of end-stage kidney disease (ESKD) [1]. IgA nephropathy presents a variable clinical course ranging from asymptomatic hematuria to rapidly progressive kidney failure [2, 3]. Proteinuria is one of the symptoms and has been established to be a robust predictor of outcome in IgA nephropathy. Three measurements are used for proteinuria evaluation in clinical practice: 24-h urine protein excretion (24-h UP), random urine protein-to-creatinine ratio (PCR), and random albuminto-creatinine ratio (ACR). Whether PCR and ACR could replace the traditional 24-h UP and which measurement of proteinuria is most associated with long-term renal outcome remain unclear. Proteinuria is a strong risk factor for renal outcomes in IgA nephropathy. Random urine protein-to-creatinine ratio (PCR), random albumin-to-creatinine ratio (ACR), and 24-h urine protein excretion (24-h UP) have been widely used in clinical practice. The measurement which is the best predictor of long-term renal outcomes remains controversial. This study aimed to compare the three measurements in IgA nephropathy
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