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Optimal Proteinuria Target for Renoprotection in Patients with IgA Nephropathy

Authors
 Ki Heon Nam  ;  Jeong Hae Kie  ;  Mi Jung Lee  ;  Tae-Ik Chang  ;  Ea Wha Kang  ;  Dong Wook Kim  ;  Beom Jin Lim  ;  Jung Tak Park  ;  Young Eun Kwon  ;  Yung Ly Kim  ;  Kyoung Sook Park  ;  Seong Yeong An  ;  Hyung Jung Oh  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Hyeon Joo Jeong  ;  Dae-Suk Han  ;  Seung Hyeok Han 
Citation
 PLoS One, Vol.9(7) : e101935, 2014 
Journal Title
 PLoS One 
ISSN
 1932-6203 
Issue Date
2014
Abstract
BACKGROUND: Proteinuria is a target for renoprotection in kidney diseases. However, optimal level of proteinuria reduction in IgA nephropathy (IgAN) is unknown. METHODS: We conducted a retrospective observational study in 500 patients with biopsy-proven IgAN. Time-averaged proteinuria (TA-P) was calculated as the mean of every 6 month period of measurements of spot urine protein-to-creatinine ratio. The study endpoints were a 50% decline in estimated glomerular filtration rate (eGFR), onset of end-stage renal disease (ESRD), and slope of eGFR. RESULTS: During a median follow-up duration of 65 (12-154) months, a 50% decline in eGFR occurred in 1 (0.8%) patient with TA-P of <0.3 g/g compared to 6 (2.7%) patients with TA-P of 0.3-0.99 g/g (hazard ratio, 2.82; P = 0.35). Risk of reaching a 50% decline in eGFR markedly increased in patients with TA-P of 1.0-2.99 g/g (P = 0.002) and those with TA-P≥3.0 g/g (P<0.001). ESRD did not occur in patients with TA-P<1.0 g/g compared to 26 (20.0%) and 8 (57.1%) patients with TA-P of 1.0-2.99 and ≥3.0 g/g, respectively. Kidney function of these two groups deteriorated faster than those with TA-P<1.0 g/g (P<0.001). However, patients with TA-P of 0.3-0.99 g/g had a greater decline of eGFR than patients with TA-P<0.3 g/g (-0.41±1.68 vs. -0.73±2.82 ml/min/1.73 m2/year, P = 0.03). CONCLUSION: In this study, patients with TA-P<1.0 g/g show favorable outcomes. However, given the faster eGFR decline in patients with TA-P of 0.3-0.99 g/g than in patients with TA-P<0.3 g/g, the ultimate optimal goal of proteinuria reduction can be lowered in the management of IgAN.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99068
Files in This Item:
T201402024.pdf Download
DOI
10.1371/journal.pone.0101935
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원)
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
강이화(Kang, Ea Wha)
권영은(Kwon, Young Eun)
기정혜(Kie, Jeong Hae)
김동욱(Kim, Dong Wook)
김영리(Kim, Yung Ly)
남기헌(Nam, Ki Heon)
박경숙(Park, Kyoung Sook)
박정탁(Park, Jung Tak) ORCID logo https://orcid.org/0000-0002-2325-8982
안성영(An, Seong Yeong)
오형중(Oh, Hyung Jung)
유태현(Yoo, Tae Hyun) ORCID logo https://orcid.org/0000-0002-9183-4507
이미정(Lee, Mi Jung)
임범진(Lim, Beom Jin) ORCID logo https://orcid.org/0000-0003-2856-0133
장태익(Chang, Tae Ik)
정현주(Jeong, Hyeon Joo) ORCID logo https://orcid.org/0000-0002-9695-1227
최규헌(Choi, Kyu Hun)
한대석(Han, Dae Suk)
한승혁(Han, Seung Hyeok) ORCID logo https://orcid.org/0000-0001-7923-5635
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