Abstract
BackgroundImmunoglobulin A nephropathy (IgAN) is one of most common forms of glomerulonephritis. At this point, the clinical impact of hyperuricemia on IgAN is not clear. The aim of the present study was to explore the clinical impact of hyperuricemia on the progression of IgAN.Study DesignMulticenter retrospective cohort study.Setting & Participants935 IgAN patients who were diagnosed by kidney biopsy at Osaka University Hospital, Osaka General Hospital, and Osaka Rosai Hospital. were included in this study.PredictorUric acid levels at renal biopsy.OutcomesThe outcome of interest was the time from the kidney biopsy to the time when a 50% increase in the baseline serum creatinine level was observed, which was defined as "progression".MeasurementsThe baseline characteristics according to the kidney biopsy at the time of diagnosis were collected from the medical records, and included age, gender, body mass index, hypertension, diabetes (use of antidiabetic drugs), serum levels of creatinine, urinary protein, smoking status, RAAS blockers and steroid therapy.ResultsAn elevated serum uric acid level was an independent risk factor for progression in female patients (per 1.0 mg/dL, multivariate-adjusted incident rate ratio 1.33 [95% confidence interval 1.07, 1.64], P = 0.008) but not in male patients (1.02 [0.81, 1.29], P = 0.855). To control a confounding effect of renal function on an association between serum uric acid level and progression in female patients, age- and serum creatinine-matched and propensity score-matched analyses were performed, and these results also supported the effect by uric acid on kidney disease progression independent of basal kidney function.LimitationsA cohort analyzed retorospectively.ConclusionsThis study revealed that an elevated uric acid level was an independent risk factor for ESKD in female IgAN patients. Therefore, uric acid might be a treatable target in female IgAN patients.
Highlights
Immunoglobulin A nephropathy (IgAN) is one of most common forms of glomerulonephritis [1], and the 30-year renal survival rate has been reported to be 50.3% [2], which indicates that its prognosis is poor
To control a confounding effect of renal function on an association between serum uric acid level and progression in female patients, age- and serum creatinine-matched and propensity scorematched analyses were performed, and these results supported the effect by uric acid on kidney disease progression independent of basal kidney function
This study revealed that an elevated uric acid level was an independent risk factor for ESKD in female IgAN patients
Summary
Immunoglobulin A nephropathy (IgAN) is one of most common forms of glomerulonephritis [1], and the 30-year renal survival rate has been reported to be 50.3% [2], which indicates that its prognosis is poor. Many reports have suggested that females are at a higher risk for uric acid-induced atherosclerotic diseases than males, whereas no evidence indicates that males experience more effects from uric acid than females. To support the idea that uric acid may be a predictor of renal function in patients with IgAN, a Finnish IgAN cohort study reported that the IgAN group with progression of renal disease had a higher baseline serum uric acid level than those in the IgAN group with stable renal function. Immunoglobulin A nephropathy (IgAN) is one of most common forms of glomerulonephritis At this point, the clinical impact of hyperuricemia on IgAN is not clear. The aim of the present study was to explore the clinical impact of hyperuricemia on the progression of IgAN.
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