Nagaraju Shankar Prasad, Rangaswamy Dharshan, Mareddy Aswani Srinivas, Prasad Srikanth, Kaza Sindhu, Shenoy Srinivas, Saraf Karan, Attur Ravindra Prabhu, Parthasarathy Rajeevalochana, Kosuru Srinivas, Mateti Uday Venkat, Guddattu Vasudeva, Koulmane Laxminarayana Sindhura Lakshmi
Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
Department of Nephrology, Guntur City Hospital, Guntur, Andhra Pradesh, India.
Saudi J Kidney Dis Transpl. 2018 Mar-Apr;29(2):318-325. doi: 10.4103/1319-2442.229261.
The role of obesity in the progression of primary glomerular diseases is controversial. A few studies report overweight/obesity as a risk factor for disease progression in immunoglobulin A nephropathy (IgAN), and the real impact of it still remains unclear. The aim of this study was to elucidate the effect of body mass index (BMI) on disease progression and proteinuria in patients with IgAN in Indian population. A cohort of biopsy-proven primary IgAN patients diagnosed between March 2010 and February 2015 who had a follow-up for a minimum of 12 months were included in the study. We defined two groups of patients according to the BMI value at diagnosis: non-obese group (Group N) with BMI <23 Kg/m and the overweight/obese group (Group O) with BMI >23 Kg/m as per Asia-Pacific task force criteria. Baseline characteristics were compared between the groups. The estimated glomerular filtration rate (eGFR) and urine protein-creatinine ratio (UPCR) were followed up at entry time, 6 months, 12 months, and at the end of follow-up. Outcomes studied were change in eGFR, proteinuria, and progression to end-stage renal disease. Statistical analysis was done using the Statistical Package for the Social Sciences version 15.0. Of 51 patients, 25 (49%) had BMI <23 kg/m (Group N) and 26 (51%) had BMI >23 kg/m (Group O) (P = 0.01). The baseline clinical, histopathological, and treatment characteristics of both the groups were comparable. The BMI at the time of diagnosis did not have any significant effect on eGFR (P = 0.41) or proteinuria (P = 0.99) at presentation. At the end of follow-up, both the groups had a similar reduction of proteinuria (UPCR) (P = 0.46) and eGFR (P = 0.20). Two patients in each group have reached chronic kidney disease Stage 5. In the present study, BMI at presentation did not have any impact on eGFR or proteinuria, either at diagnosis or at follow-up. It needs further large multicenter randomized control studies to see the effect of BMI on progression of IgAN.
肥胖在原发性肾小球疾病进展中的作用存在争议。一些研究报告称超重/肥胖是免疫球蛋白A肾病（IgAN）疾病进展的危险因素，但其实际影响仍不明确。本研究的目的是阐明体重指数（BMI）对印度人群IgAN患者疾病进展和蛋白尿的影响。本研究纳入了一组2010年3月至2015年2月间经活检证实的原发性IgAN患者，这些患者至少随访了12个月。根据诊断时的BMI值，我们将患者分为两组：根据亚太工作组标准，BMI<23 Kg/m的非肥胖组（N组）和BMI>23 Kg/m的超重/肥胖组（O组）。比较两组的基线特征。在入组时、6个月、12个月以及随访结束时对估计肾小球滤过率（eGFR）和尿蛋白肌酐比值（UPCR）进行随访。研究的结局指标包括eGFR的变化、蛋白尿以及进展至终末期肾病。使用社会科学统计软件包第15.0版进行统计分析。51例患者中，25例（49%）BMI<23 kg/m（N组），26例（51%）BMI>23 kg/m（O组）（P = 0.01）。两组的基线临床、组织病理学和治疗特征具有可比性。诊断时的BMI对就诊时的eGFR（P = 0.41）或蛋白尿（P = 0.99）没有任何显著影响。随访结束时，两组的蛋白尿（UPCR）（P = 0.46）和eGFR（P = 0.20）下降程度相似。每组各有两名患者进展至慢性肾脏病5期。在本研究中，就诊时的BMI在诊断或随访时对eGFR或蛋白尿均无任何影响。需要进一步开展大规模多中心随机对照研究来观察BMI对IgAN进展的影响。
