Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.
Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Nephrol Dial Transplant. 2022 Jun 23;37(7):1270-1280. doi: 10.1093/ndt/gfab075.
The association between a change in proteinuria over time and its impact on kidney prognosis has not been analysed in complement component 3 (C3) glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure.
This was a retrospective, multicentre observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modelling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure.
The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13-41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (hazard ratio 0.79; 95% confidence interval 0.56-0.97; P < 0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up.
The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.
补体成分 3（C3）肾小球病患者蛋白尿随时间的变化及其对肾脏预后的影响尚未进行分析。本研究旨在探讨蛋白尿随时间纵向变化与肾功能衰竭风险之间的关系。
这是一项回顾性、多中心观察性队列研究，纳入了西班牙肾小球疾病研究组 35 个肾病科的患者。研究对象为 1995 年至 2020 年间诊断为 C3 肾小球病的患者。采用线性混合效应模型联合模型评估反复测量的蛋白尿的潜在轨迹，采用 Cox 模型评估该轨迹与肾功能衰竭风险的关系。
研究组包括 85 例患者，70 例 C3 肾小球肾炎和 15 例致密沉积物病，中位年龄为 26 岁（范围 13-41 岁）。中位随访 42 个月期间，25 例患者进展为肾功能衰竭。蛋白尿的纵向变化与该结局的风险具有很强的相关性，蛋白尿水平翻倍会使风险增加 2.5 倍。第二个模型显示，随时间推移蛋白尿降低≥50%与肾功能衰竭风险降低显著相关（风险比 0.79；95%置信区间 0.56-0.97；P<0.001）。在随访的前 6 个月和 12 个月内观察到蛋白尿降低≥50%时，也观察到了这种相关性。
蛋白尿随时间的纵向变化与肾功能衰竭风险密切相关。随时间推移蛋白尿的变化可为临床医生提供对肾脏结局的动态预测。
