Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy
Background/Aims Despite controversy regarding the benefits of immunosuppressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria...
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| Language: | English |
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The Korean Association of Internal Medicine
2021-09-01
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| Series: | The Korean Journal of Internal Medicine |
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| Online Access: | http://www.kjim.org/upload/pdf/kjim-2020-240.pdf |
| _version_ | 1818586735023489024 |
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| author | Shin Chan Kang Hyung Woo Kim Tae Ik Chang Ea Wha Kang Beom Jin Lim Jung Tak Park Tae-Hyun Yoo Hyeon Joo Jeong Shin-Wook Kang Seung Hyeok Han |
| author_facet | Shin Chan Kang Hyung Woo Kim Tae Ik Chang Ea Wha Kang Beom Jin Lim Jung Tak Park Tae-Hyun Yoo Hyeon Joo Jeong Shin-Wook Kang Seung Hyeok Han |
| author_sort | Shin Chan Kang |
| collection | DOAJ |
| description | Background/Aims Despite controversy regarding the benefits of immunosuppressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria reduction after immunosuppression in IgAN patients. Methods Among 927 patients with biopsy-proven IgAN, 127 patients underwent immunosuppression. Time-averaged urine protein-creatinine ratio before and within 1 year after start of immunosuppression were calculated, and responsiveness to immunosuppression was assessed as the reduction of proteinuria between the two periods. Patients were classified into tertiles according to the extent of proteinuria reduction. We compared the slopes of estimated glomerular filtration rate (eGFR) decline using a linear mixed model, and estimated hazard ratios (HRs) for disease progression (defined as development of a ≥ 30% decline in eGFR or end-stage renal disease) using a Cox proportional hazard model. Results Median extent of proteinuria reduction was −2.1, −0.9, and −0.2 g/gCr in the first, second, and third tertiles, respectively. There were concomitant changes in the slopes of annual eGFR decline: −2.03, −2.44, and −4.62 mL/min/1.73 m2 among the first, second, and third tertiles, respectively. In multivariable Cox analysis, the HRs (95% confidence intervals) for disease progression were 0.30 (0.12 to 0.74) in the first tertile and 0.70 (0.34 to 1.45) in the second tertile compared with the thirdtertile. Conclusions This study showed that greater proteinuria reduction after immunosuppression was associated with a lower risk of disease progression in patients with IgAN, suggesting that responsiveness to immunosuppression may be an important determinant of kidney outcomes. |
| first_indexed | 2024-12-16T08:57:41Z |
| format | Article |
| id | doaj.art-53ff093517cb4cee8f23b7edfa111795 |
| institution | Directory Open Access Journal |
| issn | 1226-3303 2005-6648 |
| language | English |
| last_indexed | 2024-12-16T08:57:41Z |
| publishDate | 2021-09-01 |
| publisher | The Korean Association of Internal Medicine |
| record_format | Article |
| series | The Korean Journal of Internal Medicine |
| spelling | doaj.art-53ff093517cb4cee8f23b7edfa1117952022-12-21T22:37:15ZengThe Korean Association of Internal MedicineThe Korean Journal of Internal Medicine1226-33032005-66482021-09-013651169118010.3904/kjim.2020.240170546Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathyShin Chan Kang0Hyung Woo Kim1Tae Ik Chang2Ea Wha Kang3Beom Jin Lim4Jung Tak Park5Tae-Hyun Yoo6Hyeon Joo Jeong7Shin-Wook Kang8Seung Hyeok Han9 Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea Division of Nephrology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea Division of Nephrology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea Department of Pathology, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea Department of Pathology, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, KoreaBackground/Aims Despite controversy regarding the benefits of immunosuppressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria reduction after immunosuppression in IgAN patients. Methods Among 927 patients with biopsy-proven IgAN, 127 patients underwent immunosuppression. Time-averaged urine protein-creatinine ratio before and within 1 year after start of immunosuppression were calculated, and responsiveness to immunosuppression was assessed as the reduction of proteinuria between the two periods. Patients were classified into tertiles according to the extent of proteinuria reduction. We compared the slopes of estimated glomerular filtration rate (eGFR) decline using a linear mixed model, and estimated hazard ratios (HRs) for disease progression (defined as development of a ≥ 30% decline in eGFR or end-stage renal disease) using a Cox proportional hazard model. Results Median extent of proteinuria reduction was −2.1, −0.9, and −0.2 g/gCr in the first, second, and third tertiles, respectively. There were concomitant changes in the slopes of annual eGFR decline: −2.03, −2.44, and −4.62 mL/min/1.73 m2 among the first, second, and third tertiles, respectively. In multivariable Cox analysis, the HRs (95% confidence intervals) for disease progression were 0.30 (0.12 to 0.74) in the first tertile and 0.70 (0.34 to 1.45) in the second tertile compared with the thirdtertile. Conclusions This study showed that greater proteinuria reduction after immunosuppression was associated with a lower risk of disease progression in patients with IgAN, suggesting that responsiveness to immunosuppression may be an important determinant of kidney outcomes.http://www.kjim.org/upload/pdf/kjim-2020-240.pdfimmunoglobulin a nephropathyimmunosuppressionproteinuria |
| spellingShingle | Shin Chan Kang Hyung Woo Kim Tae Ik Chang Ea Wha Kang Beom Jin Lim Jung Tak Park Tae-Hyun Yoo Hyeon Joo Jeong Shin-Wook Kang Seung Hyeok Han Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy The Korean Journal of Internal Medicine immunoglobulin a nephropathy immunosuppression proteinuria |
| title | Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy |
| title_full | Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy |
| title_fullStr | Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy |
| title_full_unstemmed | Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy |
| title_short | Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy |
| title_sort | reduction in proteinuria after immunosuppressive therapy and long term kidney outcomes in patients with immunoglobulin a nephropathy |
| topic | immunoglobulin a nephropathy immunosuppression proteinuria |
| url | http://www.kjim.org/upload/pdf/kjim-2020-240.pdf |
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