Chinese Medical Sciences Journal ›› 2017, Vol. 32 ›› Issue (3): 145-151.doi: 10.24920/J1001-9294.2017.021

• Orginal Article • Previous Articles     Next Articles

The Neglected Significance of Glomerular Density as a 5-year Progression Indicator for IgA Nephropathy

Chen Zhen-jie, Li Hang, Cai Jian-fang, Zhang Xin, Li Chao, Zou Pei-mei, Li Ming-xi, Chen Li-meng, Li Xue-mei, Li Xue-wang*(), Wen Yu-bing   

  1. Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2016-10-06 Online:2017-09-26 Published:2017-09-27
  • Contact: Li Xue-wang E-mail:xuewanglee@126.com
  • Supported by:
    △Supported by the Key Projects in the National Science and Technology Pillar Program During the Twelfth Five-year Plan Period (2011BAI10B03).

Abstract: Objective

To investigate whether glomerular density (GD) could be an independent prognostic factor for patients of IgA nephropathy with estimated glomerular filtration rate (eGFR) of 30 to 60 ml/min per 1.73 m2, or for patients with time-average proteinuria < 0.5 g/d.

Methods

A total of 173 patients with biopsy-confirmed IgA nephropathy diagnosed from January 2000 to December 2010 were included. All of these patients were followed up for more than 5 years. The endpoint was a > 30% of decline in eGFR from baseline after 5-year follow-up. The optimal cut-off value of GD was calculated by ROC curve. Kaplan-Meier method and Cox regression analysis was used for survival analysis.

Results

A 30% of decline in eGFR occurred in 14.5% of all patients. The optimal diagnostic cut-off value of GD was 1.99/mm2 (AUC = 0.90, sensitivity = 84.0%, specificity = 81.8%) determined by ROC curve. The low GD group (GD < 1.99 per mm2) experienced a significant increase in renal endpoint for patients with eGFR of 30 to 60 ml/min per 1.73 m2 (six patients in lower GD group, while one patient in the other group). For patients with time-average proteinuria < 0.5 g/d, the lower GD group showed a higher eGFR decline from baseline (4.5±16.7 ml/min per 1.73 m2 vs. -8.1±21.4 ml/min per 1.73 m2, P = 0.038); two patients in this group reached the endpoint, while no patients in the higher GD group did.

Conclusion

GD could be an independent prognostic factor for patients of IgA nephropathy with eGFR at 30 to 60 ml/min per 1.73 m2 of body surface, particularly for those with time-averaged amount of urine protein less than 0.5 g per day.

Key words: glomerular density, IgA nephropathy, renal progression

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