Clinicopathological Characteristics and Outcomes of Immunoglobulin A Nephropathy with Different Types of Dyslipidemia: A Retrospective Single-Center Study

Abstract

<b><i>Introduction:</i></b> Immunoglobulin A nephropathy (IgAN) is one of the most common glomerulonephritic diseases in the world. Several lines of evidence have suggested that dyslipidemia is related to the disease progression and prognosis of IgAN. However, the study is scarce on the clinicopathological characteristics and outcomes of IgAN with dyslipidemia. <b><i>Methods:</i></b> This study retrospectively analyzed 234 patients with biopsy-proven idiopathic IgAN at the Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, between January 2015 and June 2021. The participants were divided into dyslipidemia (<i>n</i> = 119) and non-dyslipidemia (<i>n</i> = 115), and the dyslipidemia group was also divided into the following 4 groups: hypertriglyceridemia group, hypercholesterolemia group, mixed hyperlipidemia group, and low high-density lipoprotein cholesterol group. The estimated glomerular filtration rate (eGFR) was estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. <b><i>Results:</i></b> The prevalence of dyslipidemia in IgAN patients in our center was 50.9% (119/234). The patients with dyslipidemia presented with higher systolic blood pressure (BP), diastolic BP, serum creatinine, uric acid, hemoglobin, proteinuria, and eGFR (<i>p</i> < 0.05). Proportions of males, hypertension, and chronic kidney disease stage 2∼5 were also higher in the dyslipidemia group (<i>p</i> < 0.05). Similarly, the pathological characteristics performed were worse in the dyslipidemia group. Most dyslipidemia patients had a higher percentage of mesangial hypercellularity (M1) and tubular atrophy/interstitial fibrosis (T1∼2) in the Oxford Classification’s scoring system (<i>p</i> < 0.05). Multivariate logistic regression analysis revealed that male gender (odds ratio [OR] = 2.397, 95% confidence interval [CI]: 1.051–5.469, <i>p</i> = 0.038) and proteinuria (OR = 1.000, 95% CI: 1.000–1.001, <i>p</i> = 0.035) were possible risk factors for dyslipidemia. A total of 13 patients (13.8%) in the dyslipidemia group had an endpoint event, of which 6 patients (6.4%) had a ≥50% decrease in eGFR from baseline and 7 patients (7.4%) reached the end-stage renal disease stage. Kaplan-Meier survival curve analysis showed that patients in the dyslipidemia group had a worse outcome than those in the non-dyslipidemia group (log-rank test, <i>p</i> = 0.048). <b><i>Conclusions:</i></b> IgAN patients with dyslipidemia presented more severe clinicopathological characteristics. Male gender and proteinuria are significantly associated with the occurrence of dyslipidemia in IgAN patients. Patients in the dyslipidemia group had a worse prognosis than those in the non-dyslipidemia group, which may be essential for the disease management of IgAN and help identify the high-risk patients.

Effects of Fenofibrate and Gemfibrozil on Kynurenic Acid Production in Rat Kidneys In Vitro: Old Drugs, New Properties

“…Inappropriate lipid levels are correlated with a high cardiovascular risk and directly predispose patients to CKD development [37]. Hypertriglyceridemia is also significantly related to a worse prognosis of immunoglobulin A (IgA) nephropathy, commonly leading to CKD [38]. Thus, lipid abnormality management in patients with kidney damage seems vital, not only in terms of cardiovascular prevention and mortality risk reduction, but especially as a way to stabilize kidney function and to delay the need for kidney replacement therapies.…”

Thickened Perirenal Fat Predicts Poor Renal Outcome in Patients with Immunoglobulin A Nephropathy: A Population-Based Retrospective Cohort Study

“…Elevated lipid levels have been reported as an independent risk factor for progression of IgAN [ 23 ]. A recent study showed that IgAN patients with dyslipidemia had a worse prognosis than those in the non-dyslipidemia group [ 24 ]. Furthermore, imaging mass spectrometry analysis revealed an altered lipid distribution pattern in the tubular areas of hyper-IgA mouse kidneys [ 25 ].…”