IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m May Still Benefit from RAS Inhibition
Introduction . There has been controversy about renin-angiotensin system (RAS) inhibition in IgAN patients with advanced (stage 4) chronic kidney disease (CKD). Therefore, we investigated the effect of RAS blockade in these patients. Methods . Renal specimens of 50 IgAN patients who underwent renal...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publications
2022-12-01
|
| Series: | Journal of the Renin-Angiotensin-Aldosterone System |
| Online Access: | https://doi.org/10.1155/2022/9162427 |
| _version_ | 1797271603604619264 |
|---|---|
| author | Ying Wang Shimin Jiang Guming Zou Li Zhuo Wenge Li |
| author_facet | Ying Wang Shimin Jiang Guming Zou Li Zhuo Wenge Li |
| author_sort | Ying Wang |
| collection | DOAJ |
| description | Introduction . There has been controversy about renin-angiotensin system (RAS) inhibition in IgAN patients with advanced (stage 4) chronic kidney disease (CKD). Therefore, we investigated the effect of RAS blockade in these patients. Methods . Renal specimens of 50 IgAN patients who underwent renal biopsy during stage 4 CKD between 2010 and 2020, were stained using immunohistochemistry to detect the expression of RAS receptors (AT1R, AT2R, MasR, and MrgD). The primary endpoint was a composite of end-stage renal disease (ESRD) and death. Main baseline information and the administration of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) were collected. Results . During a median follow-up time of 25.5 months, 21 (42.0%) patients reached ESRD and none died. Six patients had a baseline eGFR of 15-20 ml/min/1.73m 2 , and reached ESRD with a median renal survival time of 7.0 (range 6.0-23.0) months. Among patients with a baseline eGFR of 20-30 ml/min/1.73m 2 , the percentage of patients using ACEI/ARB in progressive group was much lower than that in stable group (33.3% vs. 62.1%, P = 0.045 ), together with a shorter renal survival time in progressive group (26.0 vs. 30.5 months, P = 0.033 ). Macroproteinuria ( 24 h − UP ≥ 2.5 g ) was also associated with a shorter renal survival time, as well as a significant decline in eGFR of stable group (24.4 vs. 26.4 ml/min/1.73 m 2 , P = 0.026 ). Lower eGFR [hazards ratio (HR), 0.829, 95% confidence interval (CI), 0.724-0.950; P = 0.007 ] and use of ACEI/ARB (HR, 0.356, 95% CI, 0.133-0.953; P = 0.040 ) were predictive of time to ESRD in this stage. No differences were found in the expression of AT1R, AT2R, MasR, and MrgD of renal tissues at the time of biopsy between stable and progressive groups. Conclusion . Contingent on monitoring serum creatinine and potassium levels, IgAN with macroproteinuria and a GFR of 20-30 ml/min/1.73m 2 may still benefits from intrarenal RAS inhibition. |
| first_indexed | 2024-03-07T14:06:59Z |
| format | Article |
| id | doaj.art-8fb68836e2334680a245d9d808278f06 |
| institution | Directory Open Access Journal |
| issn | 1470-3203 1752-8976 |
| language | English |
| last_indexed | 2024-03-07T14:06:59Z |
| publishDate | 2022-12-01 |
| publisher | SAGE Publications |
| record_format | Article |
| series | Journal of the Renin-Angiotensin-Aldosterone System |
| spelling | doaj.art-8fb68836e2334680a245d9d808278f062024-03-06T19:05:59ZengSAGE PublicationsJournal of the Renin-Angiotensin-Aldosterone System1470-32031752-89762022-12-01202210.1155/2022/9162427IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m May Still Benefit from RAS InhibitionYing Wang0Shimin Jiang1Guming Zou2Li Zhuo3Wenge Li4 Introduction . There has been controversy about renin-angiotensin system (RAS) inhibition in IgAN patients with advanced (stage 4) chronic kidney disease (CKD). Therefore, we investigated the effect of RAS blockade in these patients. Methods . Renal specimens of 50 IgAN patients who underwent renal biopsy during stage 4 CKD between 2010 and 2020, were stained using immunohistochemistry to detect the expression of RAS receptors (AT1R, AT2R, MasR, and MrgD). The primary endpoint was a composite of end-stage renal disease (ESRD) and death. Main baseline information and the administration of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) were collected. Results . During a median follow-up time of 25.5 months, 21 (42.0%) patients reached ESRD and none died. Six patients had a baseline eGFR of 15-20 ml/min/1.73m 2 , and reached ESRD with a median renal survival time of 7.0 (range 6.0-23.0) months. Among patients with a baseline eGFR of 20-30 ml/min/1.73m 2 , the percentage of patients using ACEI/ARB in progressive group was much lower than that in stable group (33.3% vs. 62.1%, P = 0.045 ), together with a shorter renal survival time in progressive group (26.0 vs. 30.5 months, P = 0.033 ). Macroproteinuria ( 24 h − UP ≥ 2.5 g ) was also associated with a shorter renal survival time, as well as a significant decline in eGFR of stable group (24.4 vs. 26.4 ml/min/1.73 m 2 , P = 0.026 ). Lower eGFR [hazards ratio (HR), 0.829, 95% confidence interval (CI), 0.724-0.950; P = 0.007 ] and use of ACEI/ARB (HR, 0.356, 95% CI, 0.133-0.953; P = 0.040 ) were predictive of time to ESRD in this stage. No differences were found in the expression of AT1R, AT2R, MasR, and MrgD of renal tissues at the time of biopsy between stable and progressive groups. Conclusion . Contingent on monitoring serum creatinine and potassium levels, IgAN with macroproteinuria and a GFR of 20-30 ml/min/1.73m 2 may still benefits from intrarenal RAS inhibition.https://doi.org/10.1155/2022/9162427 |
| spellingShingle | Ying Wang Shimin Jiang Guming Zou Li Zhuo Wenge Li IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m May Still Benefit from RAS Inhibition Journal of the Renin-Angiotensin-Aldosterone System |
| title | IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m May Still Benefit from RAS Inhibition |
| title_full | IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m May Still Benefit from RAS Inhibition |
| title_fullStr | IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m May Still Benefit from RAS Inhibition |
| title_full_unstemmed | IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m May Still Benefit from RAS Inhibition |
| title_short | IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m May Still Benefit from RAS Inhibition |
| title_sort | iga nephropathy with macroproteinuria and a gfr of 20 30 ml min 1 73 m may still benefit from ras inhibition |
| url | https://doi.org/10.1155/2022/9162427 |
| work_keys_str_mv | AT yingwang iganephropathywithmacroproteinuriaandagfrof2030mlmin173mmaystillbenefitfromrasinhibition AT shiminjiang iganephropathywithmacroproteinuriaandagfrof2030mlmin173mmaystillbenefitfromrasinhibition AT gumingzou iganephropathywithmacroproteinuriaandagfrof2030mlmin173mmaystillbenefitfromrasinhibition AT lizhuo iganephropathywithmacroproteinuriaandagfrof2030mlmin173mmaystillbenefitfromrasinhibition AT wengeli iganephropathywithmacroproteinuriaandagfrof2030mlmin173mmaystillbenefitfromrasinhibition |