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Determination of the optimal target level of proteinuria in the management of patients with glomerular diseases by using different definitions of proteinuria

 Youn Kyung Kee  ;  Chan-Yun Yoon  ;  Seung Jun Kim  ;  Sung Jin Moon  ;  Chan Ho Kim  ;  Jung Tak Park  ;  Beom Jin Lim  ;  Tae Ik Chang  ;  Ea Wha Kang  ;  Jeong Hae Kie  ;  Tae-Hyun Yoo  ;  Hyun Joo Jeong  ;  Shin-Wook Kang  ;  Seung Hyeok Han 
 Medicine, Vol.96(44) : e8154, 2017 
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Issue Date
Adult ; Aged ; Diagnosis, Differential ; Disease Progression ; Female ; Glomerular Filtration Rate ; Glomerulonephritis/complications ; Glomerulonephritis/diagnosis ; Glomerulonephritis/mortality ; Humans ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/etiology ; Male ; Middle Aged ; Proteinuria/diagnosis ; Proteinuria/etiology ; Retrospective Studies
Proteinuria is a major determinant of adverse renal outcome, and its reduction slows renal progression in glomerular diseases. However, the optimal target of proteinuria in glomerular diseases is unclear, and discrepancies in the definition of proteinuria produce ambiguous findings. Here we investigated the optimal target of proteinuria by using different definitions of proteinuria. We analyzed 574 IgA nephropathy (IgAN), 175 membranous nephropathy (MGN), and 177 focal segmental glomerulosclerosis (FSGS) cases from 3 Korean kidney centers. We evaluated the impact of proteinuria on renal outcome with 2 definitions: time-average proteinuria (TAP) and time-varying proteinuria (TVP). The endpoint was renal progression, defined as a 50% decline in glomerular filtration rate or end-stage renal disease. During a median follow-up of 57.3 months, the primary outcome occurred in 54 patients with IgAN, 26 with MGN, and 30 with FSGS. Multivariate Cox regression using TAP indicated that there was a linear association between proteinuria and risk of renal progression in IgAN. However, moderate proteinuria was not associated with an increased risk of renal progression in MGN and FSGS. In contrast, the analysis by TVP showed that the risk significantly increased in proportion to proteinuria during follow-up in all 3 diseases. Our findings suggest that TVP-based model can delineate association between proteinuria and risk of renal progression better than TAP-based model, considering that TVP reflects the dynamic change of proteinuria over time. Thus, proteinuria reduction to the lowest possible level is required to improve renal outcomes in patients with glomerular diseases.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
박정탁(Park, Jung Tak) ORCID logo https://orcid.org/0000-0002-2325-8982
유태현(Yoo, Tae Hyun) ORCID logo https://orcid.org/0000-0002-9183-4507
임범진(Lim, Beom Jin) ORCID logo https://orcid.org/0000-0003-2856-0133
정현주(Jeong, Hyeon Joo) ORCID logo https://orcid.org/0000-0002-9695-1227
한승혁(Han, Seung Hyeok) ORCID logo https://orcid.org/0000-0001-7923-5635
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