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Multicenter Study
. 2023 Apr;27(4):340-348.
doi: 10.1007/s10157-023-02316-2. Epub 2023 Jan 27.

Prognostic factors of IgA nephropathy presenting with mild proteinuria at the time of diagnosis (a multicenter cohort study)

Sayuri Shirai  1 , Takashi Yasuda  2 , Hiroo Kumagai  3 , Hanako Matsunobu  4 , Daisuke Ichikawa  5 , Yugo Shibagaki  5 , Yoshinari Yasuda  6 , Keiichi Matsuzaki  7 , Keita Hirano  8 , Tetsuya Kawamura  9 , Yusuke Suzuki  10 , Shoichi Maruyama  11
Affiliations
Multicenter Study

Prognostic factors of IgA nephropathy presenting with mild proteinuria at the time of diagnosis (a multicenter cohort study)

Sayuri Shirai et al. Clin Exp Nephrol. 2023 Apr.

Abstract

Background: Clinical factors affecting renal prognosis in patients with immunoglobulin A nephropathy (IgAN) and low urinary protein excretion (U-Prot) remain unclear. This study evaluated such factors in patients with clinical grade I (CG-I) IgAN with U-Prot < 0.5 g/day.

Methods: This secondary analysis of a previous retrospective study included 394 patients with CG-I IgAN. The primary outcome was the first occurrence of a 1.5-fold increase in serum creatinine levels from baseline. Factors related to renal prognosis were examined using univariate and multivariate Cox regression analyses. CG-I was divided into C-Grade Ia (CG-Ia) (n = 330) with baseline eGFR ≥ 60 ml/min/1.73 m2, and C-Grade Ib (CG-Ib) (n = 64) with baseline eGFR < 60 ml/min/1.73 m2. Outcome incidence was compared between conservative and aggressive therapy (corticosteroids and/or tonsillectomy) groups.

Results: Overall outcome incidence was significantly higher in CG-Ib than in CG-Ia; the cumulative incidence was significantly higher in CG-Ib (hazard ratio, 9.67; 95% confidence interval, 2.90-32.23). Older age, higher IgA levels, eGFR < 60 mL/min/1.73 m2, lower eGFR at baseline were independent prognostic factors for CG-I. Older age, lower eGFR, higher IgA levels at baseline, and U-Prot remission at 1-year post-diagnosis were independent prognostic factors for CG-Ib. Aggressive therapy tended to suppress the cumulative outcome incidence compared with conservative therapy in CG-Ib (p = 0.087).

Conclusion: An eGFR < 60 mL/min/1.73 m2 is a significant predictor of renal prognosis in patients with IgAN and U-Prot < 0.5 g/day.

Keywords: IgA nephropathy; Mild proteinuria; Renal prognosis.

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Conflict of interest statement

The authors have declared that no conflict of interest exists.

Figures

Fig. 1
Fig. 1
Flow chart of the participant selection process
Fig. 2
Fig. 2
Comparison of the cumulative incidence of the first occurrence of a 1.5-fold increase in serum creatinine levels, from baseline or dialysis induction, between patients with CG-Ia and CG-Ib. CG clinical grade, CI confidence interval, eGFR estimated glomerular filtration rate, U-Prot urinary protein excretion
Fig. 3
Fig. 3
Comparison of the cumulative incidence of the first occurrence of a 1.5-fold increase in serum creatinine levels, from baseline or dialysis induction, between the aggressive therapy and conservative therapy groups among patients with CG-Ia and CG-Ib. CG clinical grade
See this image and copyright information in PMC

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