Abstract
The clinical course of IgA nephropathy (IgAN) and its outcome are extremely variable. Proteinuria at baseline has been considered one of the most important risk factors. More recently, mean proteinuria of follow-up (time-average proteinuria: TAp) was described as a stronger marker of renal survival, suggesting to consider it as a marker of disease activity and response to treatment. We evaluated predictors of renal survival in IgAN patients with different degrees of renal dysfunction and histological lesions, focusing on the role of the therapy in influencing TAp. We performed a retrospective analysis of three prospective, randomized, clinical trials enrolling 325 IgAN patients from 1989 to 2005. Patients were divided into 5 categories according to TAp. The primary endpoint of the 100% increase of serum creatinine occurred in 54 patients (16.6%) and renal survival was much better in groups having lower TAp. The median follow up was 66.6 months (range 12 to 144). The primary endpoint of the 100% increase of serum creatinine occurred in 54 patients (16,6%) and renal survival was much better in groups having lower TA proteinuria. At univariate analysis plasma creatinine and 24h proteinuria, systolic (SBP) and diastolic (DBP) blood pressure during follow-up and treatment with either steroid (CS) or steroid plus azathioprine (CS+A) were the main factors associated with lower TAp and renal survival. At multivariate analysis, female gender, treatment with S or S+A, lower baseline proteinuria and SBP during follow-up remained as the only variables independently influencing TAp. In conclusion, TA-proteinuria is confirmed as one of the best outcome indicators, also in patients with a severe renal insufficiency. A 6-month course of corticosteroids seems the most effective therapy to reduce TAp.
Highlights
IgA nephropathy (IgAN) is the most common glomerulonephritis in the world, in males [1]
We considered the time to the doubling of serum creatinine from baseline as the primary endpoint; secondary endpoint was the time to endstage renal disease (ESRD)
Baseline, sex, BP values measured during follow-up were all significantly associated to risk of ESRD (Table 4)
Summary
IgA nephropathy (IgAN) is the most common glomerulonephritis in the world, in males [1]. In 2004 we reported the long-term results of a randomized, controlled trial of 86 IgAN pts who received corticosteroids or supportive therapy. Similar findings were found in a recent, large trial of 207 pts, who were randomized to steroids plus azathioprine or steroids alone and followed up for a median of 5 years [9]. This observation was true for pts who either received immunosuppressant treatment or not. Coppo et al have confirmed the value of TAp in 1147 patients of the VALIGA study [10]
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