The association of 5-year therapeutic responsiveness with long-term renal outcome in IgA nephropathy
© 2022. The Author(s), under exclusive licence to The Japanese Society of Nephrology..
BACKGROUND: Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis. Since most patients have a relatively benign renal prognosis, long-term follow-up is required. During such a long course of disease, relapse of IgAN is occasionally observed after upper respiratory tract infection or without any trigger. However, little is known about the impact of relapse on long-term renal outcomes.
METHODS: In this retrospective cohort study of biopsy-proven primary IgAN, we analyzed the association of 5-year therapeutic responsiveness (relapse) with the subsequent development of end-stage kidney disease (ESKD) using a 5-year landmark analysis (Cox model) and explored predictors of relapse from histological and clinical data at baseline.
RESULTS: Among 563 patients from the exploratory cohort, most relapses (13.7%) occurred within 5 years after treatment. Using 5-year landmark analysis, among 470 patients, 79 developed ESKD during a median follow-up period of 155 months. Even after adjustment for clinicopathological relevant confounders, hazard ratios (95% confidence intervals) in the relapse and non-responder groups compared with the remission group were 2.86 (1.41-5.79) and 2.74 (1.48-5.11), respectively. Among 250 patients who achieved remission within 5 years, proteinuria, eGFR, mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, and crescent, but not interstitial fibrosis/tubular atrophy, were independent predictors of 5-year relapse in multivariable logistic regression analysis, CONCLUSIONS: Both relapsers and non-responders had similarly strong association with ESKD in patients with IgAN. We also confirmed the predictors of relapse 5 years after renal biopsy, which may guide the treatment strategies for patients with IgAN who occasionally relapse after remission.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Clinical and experimental nephrology - 26(2022), 8 vom: 15. Aug., Seite 797-807 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tsushima, Hideo [VerfasserIn] |
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| Links: |
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| Themen: |
IgA nephropathy |
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| Anmerkungen: |
Date Completed 19.07.2022 Date Revised 19.07.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s10157-022-02221-0 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM339560657 |
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| 100 | 1 | |a Tsushima, Hideo |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The association of 5-year therapeutic responsiveness with long-term renal outcome in IgA nephropathy |
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| 520 | |a © 2022. The Author(s), under exclusive licence to The Japanese Society of Nephrology. | ||
| 520 | |a BACKGROUND: Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis. Since most patients have a relatively benign renal prognosis, long-term follow-up is required. During such a long course of disease, relapse of IgAN is occasionally observed after upper respiratory tract infection or without any trigger. However, little is known about the impact of relapse on long-term renal outcomes | ||
| 520 | |a METHODS: In this retrospective cohort study of biopsy-proven primary IgAN, we analyzed the association of 5-year therapeutic responsiveness (relapse) with the subsequent development of end-stage kidney disease (ESKD) using a 5-year landmark analysis (Cox model) and explored predictors of relapse from histological and clinical data at baseline | ||
| 520 | |a RESULTS: Among 563 patients from the exploratory cohort, most relapses (13.7%) occurred within 5 years after treatment. Using 5-year landmark analysis, among 470 patients, 79 developed ESKD during a median follow-up period of 155 months. Even after adjustment for clinicopathological relevant confounders, hazard ratios (95% confidence intervals) in the relapse and non-responder groups compared with the remission group were 2.86 (1.41-5.79) and 2.74 (1.48-5.11), respectively. Among 250 patients who achieved remission within 5 years, proteinuria, eGFR, mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, and crescent, but not interstitial fibrosis/tubular atrophy, were independent predictors of 5-year relapse in multivariable logistic regression analysis, CONCLUSIONS: Both relapsers and non-responders had similarly strong association with ESKD in patients with IgAN. We also confirmed the predictors of relapse 5 years after renal biopsy, which may guide the treatment strategies for patients with IgAN who occasionally relapse after remission | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a IgA nephropathy | |
| 650 | 4 | |a Landmark analysis | |
| 650 | 4 | |a Oxford classification | |
| 650 | 4 | |a Relapse | |
| 650 | 4 | |a Renal survival | |
| 700 | 1 | |a Samejima, Ken-Ichi |e verfasserin |4 aut | |
| 700 | 1 | |a Eriguchi, Masahiro |e verfasserin |4 aut | |
| 700 | 1 | |a Uemura, Takayuki |e verfasserin |4 aut | |
| 700 | 1 | |a Tasaki, Hikari |e verfasserin |4 aut | |
| 700 | 1 | |a Fukata, Fumihiro |e verfasserin |4 aut | |
| 700 | 1 | |a Nishimoto, Masatoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Kosugi, Takaaki |e verfasserin |4 aut | |
| 700 | 1 | |a Tanabe, Kaori |e verfasserin |4 aut | |
| 700 | 1 | |a Okamoto, Keisuke |e verfasserin |4 aut | |
| 700 | 1 | |a Matsui, Masaru |e verfasserin |4 aut | |
| 700 | 1 | |a Tsuruya, Kazuhiko |e verfasserin |4 aut | |
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