Risk factors for persistent proteinuria after a 2-year combination therapy for severe childhood IgA nephropathy

Abstract

In our cohort, urinary protein excretion and rate of glomeruli with crescents at diagnosis were independent risk factors for persistent proteinuria after the combination therapy.

Early Change in Urine Protein as a Surrogate End Point in Studies of IgA Nephropathy: An Individual-Patient Meta-analysis

“…First, there is a range of pathologic evidence that degree of proteinuria correlates with greater evidence of disease. [38][39][40] Second, on an individual level, proteinuria has been widely reported to be prognostic for long-term disease progression at all stages of kidney disease, [41][42][43][44][45][46][47] and a recent study has shown that attenuation of proteinuria after steroid therapy is associated with improved prognosis. 48,49 Third, the benefit of treatment appears to be greater at higher levels of proteinuria.…”

Proteinuria rebound in IgA nephropathy associated with obesity-related glomerulopathy

“…Once considered a benign disease, IgAN is now known to progress to chronic renal failure in adulthood in as many as 50 % of patients [3]. Obesity, hypertension, proteinuria, and severe pathological scores at diagnosis are other risk factors related to the progression of IgAN [4][5][6]. Herein, we report an obese patient with IgAN who presented with rebound of proteinuria after completing combination therapy.…”

“…The concomitant presence of hypertension, dyslipidemia, hyperglycemia and/or insulin resistance, and inflammation in obesity exacerbated the renal injury from hyperfiltration [5,6]. Proteinuria [1.3 g/ 1.73 m 2 and [14 % of glomerular crescents at the time of diagnosis were risk factors for persistent proteinuria [4]. Nephrotic-range proteinuria with 10 % glomerular crescents at diagnosis suggested that rebound deterioration of proteinuria was associated with relapse and flaring up of underlying IgAN.…”

“…Fortunately, both the second and third renal biopsies revealed great improvement compared with the initial biopsy. Small cellular crescents in IgAN can subside with appropriate therapy [4]. The relapse and flaring up of IgAN were ruled out.…”

Identifying hub genes associated with clinical characteristicsin IgA nephropathy by Weighted Gene Co-expression Network Analysis

“…Because of the characteristics of renal vascular structure, early hypertension mainly affect the function of reabsorption in renal tubular and, then, increase the glomerular hyperfiltration and promote glomerular sclerosis leading to the ischemic damage of renal parenchymal, which is the particularly prominent injure in the malignant hypertensive patients. Patients diagnosed with hypertension, especially with proteinuria, generally have worse outcomes, but improved control of blood pressure can effectively reduce the incidence of adverse events [8]. Remarkably, in the progression of IgA nephropathy, the elevation and development of blood pressure is a significant sign for predicting the long-term prognosis of IgA nephropathy [9].…”