Prognostic prediction of long‐term clinical courses in individual IgA nephropathy patients

Abstract

Summary: This study was performed to evaluate predictive factors determining a long‐term prognosis in individual IgA nephropathy patients. One hundred and fifty‐five patients who have been continuously followed up for 10 years or more from the first renal biopsy in our renal unit were the subjects of this study. As predictive factors, initial proteinuria, initial creatinine clearance (Ccr) values, initial hypertension, histological severity (eight parameters and total score), persistence of massive proteinuria (% duration of massive proteinuria; % DP) and persistence of hypertension were evaluated. All 25 of the 155 patients who had either high total score of 17 or more, or less than 60 mL/min in initial Ccr values, went onto haemodialysis (HD). However, all 38 patients who had TS of 4 or less did not. The remaining 95 patients who showed both total score from 5 to16 and Ccr values of 60 mL/min or more were divided into two groups: HD group (32 cases) and non‐HD group (63 cases). All patients but one in the HD group showed 30% or more in %DP, and 50 of 63 patients in the non‐HD group snowed 30% or less (P < 0.001). Multivariate analysis using a logistic model of factors associated with prognosis indicating HD revealed that %DP was the highest relative risk (19.5) compared with interstitial fibrosis (10.2), initial Ccr values (6.8), persistent hypertension (4.2) and initial proteinuria (1.4). These results indicated that the most reliable, independent factor determining a long‐term individual prognosis is persistent massive proteinuria of 1.0 g/day or more.