Long-term Renal Outcomes In Patients Research Articles

Prognostic Value of Urinary Interleukin 6 in Patients with IgA Nephropathy: An 8-Year Follow-Up Study

We evaluated the significance of urinary IL-6 levels in the prediction of long-term renal outcome in patients with IgA nephropathy (IgAN). Fifty-nine patients with biopsy-proven IgAN were enrolled in this study. All patients had a creatinine clearance (Ccr) greater than 80 ml/min and normal serum creatinine concentration (Scr) on enrollment and were followed for 8.07 ± 1.72 years. Twenty- four-hour urine samples were obtained and urinary IL-6 was measured by ELISA. Fifteen patients exhibited a worsening of renal function (progressor). Renal function of the remaining 44 patients was stable during follow-up (non-progressor). The urinary IL-6 levels of progressors on enrollment were significantly higher than those of non-progressors (3.8 ± 3.8 and 1.8 ± 1.5 ng/day, respectively, p = 0.0138). We calculated the risk ratio for the progression to renal failure. Patients with a urinary IL-6 level greater than 2.5 ng/day at diagnosis had a 7.8-fold higher risk for the progression of the disease (95% CI 1.31–46.47, p = 0.024) compared with those whose urinary IL-6 level was less than 1.0 ng/day. In conclusion, urinary IL-6 levels could be used as a predictor of long-term renal outcome in patients with IgAN. Patients with a urinary IL-6 level greater than 2.5 ng/day at diagnosis may have a worse prognosis.

Use of methotrexate and glucocorticoids in the treatment of Wegener's granulomatosis. Long-term renal outcome in patients with glomerulonephritis.

To determine the long-term renal outcome in patients with Wegener's granulomatosis (WG) and active glomerulonephritis who were treated with methotrexate (MTX) and glucocorticoids. An open-label, prospective standardized trial using weekly low-dose MTX and glucocorticoids for the treatment of WG was performed. Forty-two patients were enrolled into the study, of whom 21 had active glomerulonephritis as a disease manifestation. The mean pretreatment level of serum creatinine in the patients with glomerulonephritis was 1.4 mg/dl. The extent of renal function in these patients at the time of their last followup was subsequently examined. Overall, 20 of 21 patients achieved renal remission. At 1 month and 6 months following study entry, the serum creatinine level in all patients either remained stable or improved. The 20 patients have now been followed up for a median time of 76 months (range 20-108 months). Only 2 patients have had a rise of >0.2 mg/dl in their creatinine level from the time of enrollment to the most recent followup examination. Of the remaining 18 patients, 12 have had stable renal function and 6 have had improvement in their creatinine levels by more than 0.2 mg/dl. In this study, the use of MTX and prednisone as initial therapy for patients with WG-related glomerulonephritis and a normal or near-normal level of serum creatinine was not associated with a long-term decline in renal function.