Background and Aims: IgA nephropathy is the most prevalent and predominantly slow progressing glomerular disease. Risk prediction tools like the international IgAN help to guide the prognosis in this group of patients. The IgA/C3 ratio has been shown to be a useful predictor of poor outcomes in Chinese cohort but such a study is lacking in the Caucasians. The study aims to investigate the utility of IgA/C3 score in predicting renal outcome in 5 years (50% decline in five years or reaching ESRD) in a Caucasian cohort. Method All available patients with biopsy-proven IgA nephropathy in our centre between January 2001 and December 2013 were included in this observational study (115 patients). Baseline (biopsy date) data relevant to the scores including demographics, laboratory and the histopathological features were collated at the time of biopsy. Follow up data on renal functions and renal outcome (50% decline in eGFR at 5 years) were collected until an arbitrary end date 31/12/2018. IgA/C3 ratio was available in 46 (40%) of the patients and this cohort wase split into two groups based on IgA/C3 ratio (A- ratio </=3 and B- ratio >3) and analysed. Results We had a total of 115 patients recorded over this 13-year period. The median age of our cohort at time of biopsy was 41 years with a predominance of male gender (71%). At baseline 84% were hypertensive and 11% diabetic. 77% were on a renin-angiotensin blocker, with 53% being on a statin. At 2 years follow-up the median decline in estimated glomerular filtration (eGFR) between the groups was similar (Group- A 2.65 ml/min vs Group- B 2 ml/min, p=0.557). At 5 years, the median decline in eGFR was higher in Group B though not statistically significant (9.3ml/min vs 4.6ml/min, p=0.475) (Table-1). At 5 years a higher IGA/C3 ratio was showing appositive corelation to the decline in eGFR (Figure–2). Conclusion Patients with higher IgA/C3 ratio had a higher drop in estimated glomerular filtration rate at five years of follow-up. Validation in a larger sample is warranted before this can be used clinically.

Background and Aims Chronic Kidney Disease (CKD) is a growing public health concern, affecting approximately 13.4% of the global population. Due to the rising burden of CKD and its economic cost, there is a pressing need to identify the risk factors which can predict CKD progression and thereby enable us to manage these patients in the community under primary care follow-up. Our study aimed to identify risk factors that can predict outcomes in patients with stable CKD. Method The study was conducted on patients recruited in the Salford Kidney Study, (a large prospective CKD database recruiting patients since 2002). From a total of 2952 recruited between 2002 and the year 2016, 1023 patients with a diagnosis of hypertension, diabetes or pyelonephritis were sampled for this study. Based on the annual rate of progression of estimated glomerular filtration rate (delta eGFR), 140 patients were identified as stable CKD patients (delta eGFR -0.50 and 0.50 ml/min/1.73m2/year). The characteristics of this group was compared with 277 rapid progressors (RP) (delta eGFR<-3) and 212 patients in the improved group (delta eGFR>0.50). Negative predictive value analysis was performed on all patients with an outcome of a GFR < 30ml/min/1.73m2. Results Stable CKD patients had a significantly higher age compared to RP ( 69 vs 62, p<0.001). Further patients in the stable CKD group had a comparatively lower median blood pressure (141.5 vs 137, p<0.001). Other factors which were identified as risk factors for rapid progression included history of diabetes (177 vs 73, p=0.021), low albumin (41 vs 44, p<0.001), raised urine protein creatinine ratio (154.6 vs 18.8, p<0.001) and phosphate (1.24 vs 1.12, p<0.001) (Table-1). Comparing outcomes showed rapid progression reached ESRD (172 vs 18, p<0.001) but no significant difference in mortality (93 vs 55, p=0.25). Characteristics that were statistically different for stable CKD patients in this large cohort were identified: age, systolic blood pressure, diastolic blood pressure, diabetes, albumin, UPCR and phosphate. NPV analysis did not identify reveal any clear predictors for progression in stable CKD patients. Conclusion Several risk factors were identified to distinguish between stable, rapid and improved group. NPV did not identify any predictors in stable group. Further risk prediction models incorporating biomarkers are warranted to identify factors that can guide prognosis thereby stable CKD patients can be managed in the community.

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Background and Aims IgA nephropathy is the most prevalent cause of glomerular disease worldwide. The international IgA risk prediction (IgAN) score is a well validated tool to predict the risk of 50% decline in eGFR or end stage renal disease (ESRD) at five years after biopsy in patients with IgA nephropathy. Also, the four variable kidney failure risk equation (KFRE) is another validated tool used to predict the two- and five-year risk of progression to ESRD of all cause chronic kidney disease (CKD 3-5). Our aim is to compare the predictive utility of IgAN score and the KFRE in a real-world cohort of Caucasian patients with long-term follow-up data. Method All available patients with biopsy-proven IgA nephropathy in our centre between January 2001 and December 2013 were included in this observational study. Baseline (biopsy date) data relevant to the scores including demographics, laboratory and the histopathological features were collated at the time of biopsy. Follow up data on renal functions and renal outcome (50% decline in eGFR or reaching ESRD) were collected until an arbitrary end date 31/12/2018. Results We had a total of 115 patients recorded over this 13-year period. The median age of our cohort at time of biopsy was 41 years. Men represented 71% of the cohort. At baseline 84% were hypertensive and 11% diabetic. 77% were on a renin-angiotensin blocker, with 53% being on a statin. Out of the 115 patients, 74 were eligible to undergo analysis. The percentage risk of reaching the endpoint (50% decline in eGFR or reaching ESRD) was calculated at 2 years and 5 years for all patients. These results can be seen in table 1 and 2. At 2 years, 7 patients had reached the endpoint: 2 patients had a >50% decline in eGFR, 3 patients received RRT and 2 patients underwent transplantation. At 5 years, 14 patients had reached the endpoint: 3 patients had a >50% decline in eGFR, 6 patients received RRT and 5 underwent transplantation. Conclusion Our data suggests that the KRFE tool underpredicts the risk of reaching endpoint, compared to the IgAN. Our study has helped to compare the two tools, but further statistical validation is required using a larger cohort.