Reduction in proteinuria after immunosuppres-sive therapy and long-term kidney outcomes in patients with immunoglobulin a nephropathy

Shin Chan Kang, Hyung Woo Kim, Tae Ik Chang, Ea Wha Kang, Beom Jin Lim, Jung Tak Park, Tae Hyun Yoo, Hyeon Joo Jeong, Shin Wook Kang, Seung Hyeok Han

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aims: Despite controversy regarding the benefits of immunosup-pressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria reduction after immunosuppression in IgAN patients. Methods: Among 927 patients with biopsy-proven IgAN, 127 patients underwent immunosuppression. Time-averaged urine protein-creatinine ratio before and within 1 year after start of immunosuppression were calculated, and responsiveness to immunosuppression was assessed as the reduction of proteinuria between the two periods. Patients were classified into tertiles according to the extent of proteinuria reduction. We compared the slopes of estimated glomerular filtration rate (eGFR) decline using a linear mixed model, and estimated hazard ratios (HRs) for disease progression (defined as development of a ≥ 30% decline in eGFR or end-stage renal disease) using a Cox proportional hazard model. Results: Median extent of proteinuria reduction was –2.1, –0.9, and –0.2 g/gCr in the first, second, and third tertiles, respectively. There were concomitant chang-es in the slopes of annual eGFR decline: –2.03, –2.44, and –4.62 mL/min/1.73 m2 among the first, second, and third tertiles, respectively. In multivariable Cox anal-ysis, the HRs (95% confidence intervals) for disease progression were 0.30 (0.12 to 0.74) in the first tertile and 0.70 (0.34 to 1.45) in the second tertile compared with the thirdtertile. Conclusions: This study showed that greater proteinuria reduction after immu-nosuppression was associated with a lower risk of disease progression in patients with IgAN, suggesting that responsiveness to immunosuppression may be an important determinant of kidney outcomes.

Original languageEnglish
Pages (from-to)1169-1180
Number of pages12
JournalKorean Journal of Internal Medicine
Volume36
Issue number5
DOIs
Publication statusPublished - 2021 Sept

Bibliographical note

Publisher Copyright:
© 2021 The Korean Association of Internal Medicine.

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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