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Comparative Study
. 2012 Sep;7(9):1401-8.
doi: 10.2215/CJN.04500511. Epub 2012 Jul 12.

Clinical outcomes and predictors for ESRD and mortality in primary GN

Yu-Hsiang Chou  1 , Yu-Chung Lien, Fu-Chang Hu, Wei-Chou Lin, Chih-Chin Kao, Chun-Fu Lai, Wen-Chih Chiang, Shuei-Liong Lin, Tun-Jun Tsai, Kwan-Dun Wu, Yung-Ming Chen
Affiliations
Comparative Study

Clinical outcomes and predictors for ESRD and mortality in primary GN

Yu-Hsiang Chou et al. Clin J Am Soc Nephrol. 2012 Sep.

Abstract

Background and objectives: Relatively little is known about the long-term outcomes of different histologic types of primary glomerulonephritis in Asian populations.

Design, setting, participants, & measurements: From 1993 to 2006, 987 patients undergoing renal biopsy were studied, and 580 patients (mean age=44.4 years, male=58.5%) with the four most common forms of glomerulonephritis (membranous nephropathy, focal and segmental glomerulosclerosis, IgA nephropathy, and minimal change disease) were selected for analysis. Median follow-up period was 5.9 (interquartile range=5.7) years.

Results: The focal and segmental glomerulosclerosis group displayed the highest incidence of ESRD (25.8%) and the fastest decline of estimated GFR (4.6 ml/min per 1.73 m(2) per year). The IgA nephropathy group also had a higher rate of ESRD than the membranous nephropathy patients (19.2% versus 4.3%, P<0.001). In contrast, the membranous nephropathy group exhibited an overall death rate similar to the focal and segmental glomerulosclerosis group (17.2% versus 14.4%) but higher than the IgA nephropathy and minimal change disease patients (4.6% and 3.7%, respectively, P<0.001). The most powerful predictor for ESRD was focal and segmental glomerulosclerosis, whereas the strongest predictor for all-cause mortality was membranous nephropathy with higher proteinuria. Protectors against ESRD included male sex and higher hemoglobin.

Conclusions: Most predictors for ESRD and overall mortality found in this ethnic Chinese cohort were similar to other studies. However, some risk factors linked with distinct glomerular pathologies displayed differential clinical outcomes.

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Figures

Figure 1.
Figure 1.
Flowchart of the participants in the cohort. ATN, acute tubular necrosis; DMN, diabetic nephropathy; FSGS, focal and segmental glomerulosclerosis; IgAN, IgA nephropathy; MCD, minimal change disease; MesPGN, mesangioproliferative glomerulonephritis; MN, membranous nephropathy; MPGN, membranoproliferative glomerulonephritis; RPGN, rapidly progressive glomerulonephritis; TIN, tubulointerstitial nephritis.
Figure 2.
Figure 2.
Renal survival in patients with the four most common types of primary glomerulonephritis. FSGS, focal and segmental glomerulosclerosis; IgAN, IgA nephropathy; MCD, minimal change disease; MN, membranous nephropathy.
Figure 3.
Figure 3.
Patient survival in patients with the four most common types of primary glomerulonephritis. FSGS, focal and segmental glomerulosclerosis; IgAN, IgA nephropathy; MCD, minimal change disease; MN, membranous nephropathy.
See this image and copyright information in PMC

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