The Neglected Significance of Glomerular Density as a 5-year Progression Indicator for IgA Nephropathy<sup>△</sup>

Your Location：

Home >

Browse articles >

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

Chinese Medical Sciences Journal Vol. 32, Issue 3, Pages: 145-151(2017)

Orginal Article | Updated：2024-04-10

|

- The Neglected Significance of Glomerular Density as a 5-year Progression Indicator for IgA Nephropathy^△
- Affiliations：
  
  Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Author bio：
  
  *Corresponding author Tel: 86-10-69158744, Fax: 86-10-69155088, E-mail: xuewanglee@126.com
- Funds：
- DOI：10.24920/J1001-9294.2017.021
  CLC：
- Received：06 October 2016，
  
  Published Online：26 September 2017，
  
  Published：2017-09
- Accepted：
Scan QR Code
Chen Zhen-jie, Li Hang, Cai Jian-fang, et al. The Neglected Significance of Glomerular Density as a 5-year Progression Indicator for IgA Nephropathy^△[J]. Chinese medical sciences journal, 2017, 32(3): 145-151.
DOI：

Chen Zhen-jie, Li Hang, Cai Jian-fang, et al. The Neglected Significance of Glomerular Density as a 5-year Progression Indicator for IgA Nephropathy^△[J]. Chinese medical sciences journal, 2017, 32(3): 145-151. DOI： 10.24920/J1001-9294.2017.021.

摘要

目的

评估肾小球皮质密度（glomerular density

GD）是否可以作为估测肾小球滤过率（estimated glomerular filtration rate，eGFR）在30到60 ml/(min·1.73 m2)的IgA肾病患者以及随访中时间平均蛋白尿

<

0.5 g/d患者预后不良的独立危险因素。

方法

入组2000年1月至2010年12月在本院经肾脏穿刺诊断为IgA肾病、且随访时间大于5年的173例患者。主要终点事件为随访5年后eGFR较基线值下降大于30%。采用ROC曲线计算GD的诊断界值，采用Kaplan-Meier生存分析及Cox回归分析评估预后。

结果

随访期间14.5%的患者eGFR下降超过30%。GD对于IgA肾病预后的诊断界值为1.99/mm2（ROC下曲线面积=0.90

敏感性=84.0%，特异性=81.8%）。对于eGFR在30到60 ml/(min·1.73 m2)的IgA肾病患者，更多的低GD患者（GD

<

1.99 / mm2）发生终点事件（低GD组6例，高GD组1例）。对于时间平均蛋白尿

<

0.5 g/d的患者

低GD 组的eGFR下降更显著[4.5±16.7 ml/(min·1.73 m2) 与 -8.1±21.4 ml/(min·1.73 m2)

P = 0.038]；低GD组中2例患者随访中出现终点事件，而高GD组无终点事件发生。

结论

GD是eGFR在30到60 ml/(min·1.73 m2)及随访中时间平均蛋白尿

<

0.5 g/d的IgA肾病患者的独立危险因素。

Abstract

Objective

2

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 m

2

or for patients with time-average proteinuria

<

0.5 g/d.

Methods

2

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

2

A 30% of decline in eGFR occurred in 14.5% of all patients. The optimal diagnostic cut-off value of GD was 1.99/mm

2

(AUC = 0.90

sensitivity = 84.0%

specificity = 81.8%) determined by ROC curve. The low GD group (GD

<

1.99 per mm

2

) experienced a significant increase in renal endpoint for patients with eGFR of 30 to 60 ml/min per 1.73 m

2

(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 m

2

vs

. -8.1±21.4 ml/min per 1.73 m

2

P

= 0.038); two patients in this group reached the endpoint

while no patients in the higher GD group did.

Conclusion

2

GD could be an independent prognostic factor for patients of IgA nephropathy with eGFR at 30 to 60 ml/min per 1.73 m

2

of body surface

particularly for those with time-averaged amount of urine protein less than 0.5 g per day.

关键词

Keywords

references

Wyatt RJ , Julian BA. IgA nephropathy. N Engl J Med 2013 ; 368 ( 25 ): 2402 - 14 . doi: 10.1056/NEJMra1206793 10.1056/NEJMra1206793 .

Elsherbiny HE , Alexander MP , Kremers WK , Park WD , Poggio ED , Prieto M , et al. Nephron hypertrophy and glomerulosclerosis and their association with kidney function and risk factors among living kidney donors. Clin J Am Soc Nephrol 2014 ; 9 ( 11 ): 1892 - 902 . doi: 10.2215/ CJN.02560314 10.2215/ CJN.02560314 .

Tsuboi N , Kawamura T , Koike K , Okonogi H , Hirano K , Hamaguchi A , et al. Glomerular density in renal biopsy specimens predicts the long-term prognosis of IgA nephropathy. Clin J Am Soc Nephrol 2010 ; 5 ( 1 ): 39 - 44 . doi: 10.2215/CJN.04680709 10.2215/CJN.04680709 .

Hewitson TD , Darby IA , Bisucci T , Jones CL , Becker GJ. Evolution of tubulointerstitial fibrosis in experimental renal infection and scarring. J Am Soc Nephrol 1998 ; 9 ( 4 ): 632 - 42 .

Le W , Liang S , Hu Y , Deng K , Bao H , Zeng C , et al. Long-term renal survival and related risk factors in patients with IgA nephropathy: results from a cohort of 1155 cases in a Chinese adult population. Nephrol Dial Transplant 2012 ; 27 ( 4 ): 1479 - 85 . doi: 10.1093/ndt/gfr527 10.1093/ndt/gfr527 .

Coppo R , Troyanov S , Bellur S , Cattran D , Cook HT , Feehally J , et al. Validation of the Oxford classification of IgA nephropathy cohorts with different presentations and treatments. Kidney Int 2014 ; 86 ( 4 ): 828 - 36 . doi: 10. 1038/ki.2014.63 10. 1038/ki.2014.63 .

Sarcina C , Tinelli C , Ferrario F , Visciano B , Pani A , De Silvestri A , et al. Corticosteroid treatment influences TA-proteinuria and renal survival in IgA nephropathy. PLoS One 2016 ; 11 ( 7 ): e0158584 . doi: 10.1371/journal.pone. 0158584 10.1371/journal.pone. 0158584 .

Levey AS , Stevens LA , Schmid CH , Zhang YL , Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009 ; 150 ( 9 ): 604 - 12 . doi: 10.7326/0003-4819-150-9-200905050-00006 10.7326/0003-4819-150-9-200905050-00006 .

Coresh J , Turin TC , Matsushita K , Sang Y , Ballew SH , Appel LJ , et al. Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. JAMA 2014 ; 311 ( 24 ): 2518 - 31 . doi: 10.1001/ jama.2014.6634 10.1001/ jama.2014.6634 .

Levey AS , Inker LA , Matsushita K , Greene T , Willis K , Lewis E , et al. GFR decline as an end point for clinical trials in CKD: a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration. Am J Kidney Dis 2014 ; 64 ( 6 ): 821 - 35 . doi: 10.1053/j.ajkd.2014.07.030 10.1053/j.ajkd.2014.07.030 .

Working Group of the International IgA Nephropathy Network and the Renal Pathology Society , Cattran DC , Coppo R , Cook HT , Feehally J , Roberts IS , et al . The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int 2009 ; 76 ( 5 ): 534 - 45 . doi: 10.1038/ki.2009.243 10.1038/ki.2009.243 .

Trimarchi H , Barratt J , Cattran DC , Cook HT4, Coppo R, Haas M, et al. Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group. Kidney Int 2017 ; 91 ( 5 ): 1014 - 21 . doi: 10.1016/j.kint.2017.02.003 10.1016/j.kint.2017.02.003 .

Hoy WE , Bertram JF , Hughson MD. Nephron hypertrophy and glomerulosclerosis in normal donor kidneys. Clin J Am Soc Nephrol 2014 ; 9 ( 11 ): 1832 - 4 . doi: 10.2215/CJN. 08680814 10.2215/CJN. 08680814 .

Luyckx VA , Brenner BM. Birth weight, malnutrition and kidney-associated outcomes—a global concern. Nat Rev Nephrol 2015 ; 11 ( 3 ): 135 - 49 . doi: 10.1038/nrneph.2014.251 10.1038/nrneph.2014.251 .

Koike K , Ikezumi Y , Tsuboi N , Kanzaki G , Haruhara K , Okabayashi Y , et al. Glomerular density and volume in renal biopsy specimens of children with proteinuria relative to preterm birth and gestational age. Clin J Am Soc Nephrol 2017 ; 12 ( 4 ): 585 - 90 . doi: 10.2215/CJN.05650516 10.2215/CJN.05650516 .

Haruhara K , Tsuboi N , Kanzaki G , Koike K , Suyama M , Shimizu A , et al. Glomerular density in biopsy-proven hypertensive nephrosclerosis. Am J Hypertens 2015 ; 28 ( 9 ): 1164 - 71 . doi: 10.1093/ajh/hpu267 10.1093/ajh/hpu267 .

Nyengaard J , Bendtsen T. Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Anat Rec 1992 ; 232 ( 2 ): 194 - 201 . doi: 10.1002/ar.1092320205 10.1002/ar.1092320205 .

Tsuboi N , Utsunomiya Y , Kanzaki G , Koike K , Ikegami M , Kawamura T , et al. Low glomerular density with glomerulomegaly in obesity-related glomerulopathy. Clin J Am Soc Nephrol 2012 ; 7 ( 5 ): 735 - 41 . doi: 10.2215/CJN.07270711 10.2215/CJN.07270711 .

Koike K , Tsuboi N , Utsunomiya Y , Kawamura T , Hosoya T. Glomerular density-associated changes in clinicopathological features of minimal change nephrotic syndrome in adults. Am J Nephrol 2011 ; 34 ( 6 ): 542 - 8 . doi: 10.1159/ 000334360 10.1159/ 000334360 .

Radhakrishnan J , Cattran DC. The KDIGO practice guideline on glomerulonephritis: reading between the (guide) lines—application to the individual patient. Kidney Int 2012 ; 82 ( 8 ): 840 - 56 . doi: 10.1038/ki.2012.280 10.1038/ki.2012.280 .

Tesar V1 , Troyanov S , Bellur S , Verhave JC , Cook HT , Feehally J , et al . Corticosteroids in IgA nephropathy: a retrospective analysis from the VALIGA study. J Am Soc Nephrol 2015 ; 26 ( 9 ): 2248 - 58 . doi: 10.1681/ASN.20140 70697 10.1681/ASN.20140 70697 .

Rauen T , Eitner F , Fitzner C , Sommerer C , Zeier M , Otte B , et al. Intensive supportive care plus immunosuppression in IgA nephropathy. N Engl J Med 2015 ; 373 ( 23 ): 2225 - 36 . doi: 10.1056/NEJMoa1415463 10.1056/NEJMoa1415463 .

0

Views

895

Downloads

0

CSCD

>

Alert me when the article has been cited

Submit

Publicity Resources

Related Articles

No data

Related Author

No data

Related Institution

No data

⁰