POS-528 PROGNOSIS OF IGA PATIENT AFTER THREE CONSEQUENT REMISSION IN PROTEINURIA AND HEMATURIA OVER SIX MONTHS OF FOLLOW-UP

Abstract

Definition of hematuria and proteinuria remission in IgA nephropathy (IgAN) has not been well established in clinical studies. Recently, the Japanese Society of Nephrology (JSN) proposed criterias for hematuria and proteinuria remission. The objective of the present study was to analyze utility of JSN criteria for hematuria and proteinuria remission with renal outcomes after intensive treatment. This was a retrospective study included 75 IgAN patients diagnosed and treated with methyl-prednisolone pulse therapy between 2003 and 2014 in Nagoya University Hospital. Renal outcomes defined as composite endpoints of 50% eGFR reduction and/ or initiation of hemodialysis. During Mean observation time of 10.4±3.5 years 14 patients (18.67%) met renal outcome, and 62(82.7%), 54 (82.7%) patients showed proteinuria and hematuria remission respectively. with a post-remission period of 22.46±21.47 months 45.16% remained remission in proteinuria and 27.78% remained remission in hematuria. In adjusted Cox-regression analysis, patients with proteinuria remission revealed favorable renal prognosis (HR 0.24, 95%CI 0.06-0.90, p=0.03). Whereas, 54.84% patients relapses in proteinuria and 72.22% relapses in hematuria. Among 14 patients with proteinuria and hematuria relapses, thirteen patients (21.0%) received immunosuppressive drugs in combination with steroid. Predictors of proteinuria relapses were time to first remission (OR 5.88, p=0.02), and E-score (OR 7.31, p=0.01). Proteinuria remission indicates a favorable renal outcome in IgAN patients, but relapses are common and, in a small percentage poor renal outcomes occurred. Therefore our data suggest that even relapses cases should be monitored on a regular basis.