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Optimal Proteinuria Target for Renoprotection in Patients with IgA Nephropathy

Authors
 Ki Heon Nam  ;  Jeong Hae Kie  ;  Seung Hyeok Han  ;  Dae-Suk Han  ;  Hyeon Joo Jeong  ;  Kyu Hun Choi  ;  Shin-Wook Kang  ;  Tae-Hyun Yoo  ;  Hyung Jung Oh  ;  Seong Yeong An  ;  Kyoung Sook Park  ;  Yung Ly Kim  ;  Young Eun Kwon  ;  Jung Tak Park  ;  Beom Jin Lim  ;  Dong Wook Kim  ;  Ea Wha Kang  ;  Tae-Ik Chang  ;  Mi Jung Lee 
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
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) ; 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) ; 안성영(An, Seong Yeong) ; 오형중(Oh, Hyung Jung) ; 유태현(Yoo, Tae Hyun) ; 이미정(Lee, Mi Jung) ; 임범진(Lim, Beom Jin) ; 장태익(Chang, Tae Ik) ; 정현주(Jeong, Hyeon Joo) ; 최규헌(Choi, Kyu Hun) ; 한대석(Han, Dae Suk) ; 한승혁(Han, Seung Hyeok)
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