Optimal proteinuria target for renoprotection in patients with IgA nephropathy

Ki Heon Nam, Jeong Hae Kie, Mi Jung Lee, Tae Ik Chang, Ea Wha Kang, Dong Wook Kim, Beom Jin Lim, Jung Tak Park, Young Eun Kwon, Yung Ly Kim, Kyoung Sook Park, Seong Yeong An, Hyung Jung Oh, TaeHyun Yoo, Shin-Wook Kang, Kyu Hun Choi, Hyeon Joo Jeong, Dae Suk Han, SeungHyeok Han

Research output: Contribution to journalArticle

12 Citations (Scopus)

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 m 2 /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.

Original languageEnglish
Article numbere101935
JournalPloS one
Volume9
Issue number7
DOIs
Publication statusPublished - 2014 Jul 8

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kidney diseases
Proteinuria
Immunoglobulin A
glomerular filtration rate
Glomerular Filtration Rate
Biopsy
proteinuria
Creatinine
Hazards
Chronic Kidney Failure
Kidney Diseases
observational studies
renal function
Proteins
endpoints
creatinine
Observational Studies
biopsy
urine
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Nam, K. H., Kie, J. H., Lee, M. J., Chang, T. I., Kang, E. W., Kim, D. W., ... Han, S. (2014). Optimal proteinuria target for renoprotection in patients with IgA nephropathy. PloS one, 9(7), [e101935]. https://doi.org/10.1371/journal.pone.0101935
Nam, Ki Heon ; Kie, Jeong Hae ; Lee, Mi Jung ; Chang, Tae Ik ; Kang, Ea Wha ; Kim, Dong Wook ; Lim, Beom Jin ; Park, Jung Tak ; Kwon, Young Eun ; Kim, Yung Ly ; Park, Kyoung Sook ; An, Seong Yeong ; Oh, Hyung Jung ; Yoo, TaeHyun ; Kang, Shin-Wook ; Choi, Kyu Hun ; Jeong, Hyeon Joo ; Han, Dae Suk ; Han, SeungHyeok. / Optimal proteinuria target for renoprotection in patients with IgA nephropathy. In: PloS one. 2014 ; Vol. 9, No. 7.
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title = "Optimal proteinuria target for renoprotection in patients with IgA nephropathy",
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 m 2 /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.",
author = "Nam, {Ki Heon} and Kie, {Jeong Hae} and Lee, {Mi Jung} and Chang, {Tae Ik} and Kang, {Ea Wha} and Kim, {Dong Wook} and Lim, {Beom Jin} and Park, {Jung Tak} and Kwon, {Young Eun} and Kim, {Yung Ly} and Park, {Kyoung Sook} and An, {Seong Yeong} and Oh, {Hyung Jung} and TaeHyun Yoo and Shin-Wook Kang and Choi, {Kyu Hun} and Jeong, {Hyeon Joo} and Han, {Dae Suk} and SeungHyeok Han",
year = "2014",
month = "7",
day = "8",
doi = "10.1371/journal.pone.0101935",
language = "English",
volume = "9",
journal = "PLoS One",
issn = "1932-6203",
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number = "7",

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Nam, KH, Kie, JH, Lee, MJ, Chang, TI, Kang, EW, Kim, DW, Lim, BJ, Park, JT, Kwon, YE, Kim, YL, Park, KS, An, SY, Oh, HJ, Yoo, T, Kang, S-W, Choi, KH, Jeong, HJ, Han, DS & Han, S 2014, 'Optimal proteinuria target for renoprotection in patients with IgA nephropathy', PloS one, vol. 9, no. 7, e101935. https://doi.org/10.1371/journal.pone.0101935

Optimal proteinuria target for renoprotection in patients with IgA nephropathy. / Nam, Ki Heon; Kie, Jeong Hae; Lee, Mi Jung; Chang, Tae Ik; Kang, Ea Wha; Kim, Dong Wook; Lim, Beom Jin; Park, Jung Tak; Kwon, Young Eun; Kim, Yung Ly; Park, Kyoung Sook; An, Seong Yeong; Oh, Hyung Jung; Yoo, TaeHyun; Kang, Shin-Wook; Choi, Kyu Hun; Jeong, Hyeon Joo; Han, Dae Suk; Han, SeungHyeok.

In: PloS one, Vol. 9, No. 7, e101935, 08.07.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Optimal proteinuria target for renoprotection in patients with IgA nephropathy

AU - Nam, Ki Heon

AU - Kie, Jeong Hae

AU - Lee, Mi Jung

AU - Chang, Tae Ik

AU - Kang, Ea Wha

AU - Kim, Dong Wook

AU - Lim, Beom Jin

AU - Park, Jung Tak

AU - Kwon, Young Eun

AU - Kim, Yung Ly

AU - Park, Kyoung Sook

AU - An, Seong Yeong

AU - Oh, Hyung Jung

AU - Yoo, TaeHyun

AU - Kang, Shin-Wook

AU - Choi, Kyu Hun

AU - Jeong, Hyeon Joo

AU - Han, Dae Suk

AU - Han, SeungHyeok

PY - 2014/7/8

Y1 - 2014/7/8

N2 - 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 m 2 /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.

AB - 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 m 2 /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.

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DO - 10.1371/journal.pone.0101935

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Nam KH, Kie JH, Lee MJ, Chang TI, Kang EW, Kim DW et al. Optimal proteinuria target for renoprotection in patients with IgA nephropathy. PloS one. 2014 Jul 8;9(7). e101935. https://doi.org/10.1371/journal.pone.0101935