Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España.
Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España.
Nefrologia (Engl Ed). 2021 May-Jun;41(3):311-320. doi: 10.1016/j.nefro.2020.12.011. Epub 2021 Mar 23.
About 25% of patients with IgA nephropathy (IgAN) progress to stage 5 chronic kidney disease (CKD) after years of evolution. Various tools have been developed in recent years designed to predict which of the patients will had poorer outcomes. The value of circulating galactosyl-deficient IgA1 (Gd-IgA1) has been related to a worse evolution of IgAN in several studies. There are also some publications that relate higher APRIL values with a worse evolution. Recently, a new method has been developed that allows measuring the value of circulating Gd-IgA1 in a simpler way than those previously available. The objective of this study is to analyze the influence of circulating Gd-IgA1, measured by this method, on the progression of IgAN.
Forty-nine patients with a diagnosis of IgAN demonstrated by renal biopsy were selected in our center, without having received prior immunosuppressive treatment, for whom frozen serum was available. The median follow-up was 4 years. Gd-IgA1 was measured by lectin-independent ELISA with the monoclonal antibody KM55 (IgA1 kit Cat. No. 30111694. IBL Int., Hamburg, Germany). Likewise, APRIL levels were also measured in these patients.
19 (38.8%) patients reached stage 5 CKD. The fourth quartile of circulating Gd-IgA1 was related to a higher cumulative risk of reaching stage 5 CKD in the Kaplan-Meier analysis (risk at the 5th year 39.4% vs. 24.3%, log rank p=0.019). The Gd-IgA1 value was related to an increased risk of CKD stage 5 (HR 1.147, 95% CI 1.035-1.270, p=0.009), regardless of glomerular filtration rate, proteinuria, the percentage of sclerosed glomeruli and the value of segmental sclerosis. We did not find significant differences in the APRIL values.
The value of circulating Gd-IgA1 measured by the monoclonal antibody KM55 is related to a worse evolution of patients with IgAN independently of other variables, so it could be included in the study of patients to improve the prediction of the risk of disease progression.
在经过数年的发展后，约 25%的 IgA 肾病（IgAN）患者会进展为 5 期慢性肾脏病（CKD）。近年来，已经开发出各种工具来预测哪些患者的预后较差。在几项研究中，循环半乳糖缺乏 IgA1（Gd-IgA1）的水平与 IgAN 的恶化有关。也有一些文献报道，较高的 APRIL 值与恶化有关。最近，开发了一种新方法，可以更简单地测量循环 Gd-IgA1 的值。本研究的目的是分析通过该方法测量的循环 Gd-IgA1 对 IgAN 进展的影响。
在本中心选择了 49 名经肾活检证实的 IgAN 患者，这些患者在未接受免疫抑制治疗的情况下接受了治疗，并为他们提供了冷冻血清。中位随访时间为 4 年。通过与单克隆抗体 KM55（IgA1 试剂盒 Cat. No. 30111694。IBL Int.，汉堡，德国）非依赖凝集素的 ELISA 法测量 Gd-IgA1。同样，也测量了这些患者的 APRIL 水平。
19 名（38.8%）患者达到 5 期 CKD。Kaplan-Meier 分析显示，循环 Gd-IgA1 的第四四分位数与达到 5 期 CKD 的累积风险更高相关（第 5 年的风险为 39.4% vs. 24.3%，对数秩检验 p=0.019）。Gd-IgA1 值与 CKD 5 期风险增加相关（HR 1.147，95%CI 1.035-1.270，p=0.009），与肾小球滤过率、蛋白尿、硬化肾小球的百分比和节段性硬化的价值无关。我们没有发现 APRIL 值的显著差异。
通过单克隆抗体 KM55 测量的循环 Gd-IgA1 值与 IgAN 患者的恶化有关，与其他变量无关，因此可以纳入患者的研究中，以提高疾病进展风险的预测能力。
