Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
Renal Department, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Salford, United Kingdom.
PLoS One. 2022 Sep 1;17(9):e0268421. doi: 10.1371/journal.pone.0268421. eCollection 2022.
IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide, with an incidence of 2.5 per 100,000 population per year. The 10-year risk of progression to end stage kidney disease (ESKD) or halving of eGFR is 26%. Here we aimed to collect a comprehensive dataset of IgAN patients at our centre over 2 decades to provide real world data, describe outcomes and determine the effects of immunosuppression use.
DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: All patients diagnosed with biopsy-proven IgAN at our centre over 2 decades were identified. After exclusions, the total cohort size was 401. Data relating to (i) baseline demographics, (ii) laboratory and urine results, (iii) histological data, and (iv) outcomes of initiation of renal replacement therapy (RRT) and mortality were collected.
The median age was 45.0 years, with 69.6% male and 57.6% hypertensive; 20.4% received immunosuppression, 29.7% progressed to RRT and 19.7% died, over a median follow up period of 51 months. Baseline eGFR was 46.7ml/min/1.73m2 and baseline uPCR was 183mg/mmol. Median rate of eGFR decline was -1.31ml/min/1.73m2/year. Those with a higher MEST-C score had worse outcomes. Immunosuppression use was associated with an increased rate of improvement in proteinuria, but not with a reduction in RRT or mortality. Factors favouring improved outcomes with immunosuppression use included female gender; lower age, blood pressure and T-score; higher eGFR; and ACEi/ARB use.
A variety of clinical and histological factors are important in determining risk of progression in IgAN. Therapeutic interventions, particularly use of immunosuppression, should be individualised and guided by these factors.
IgA 肾病（IgAN）是全球最常见的肾小球肾炎，年发病率为每 10 万人 2.5 例。10 年内进展为终末期肾病（ESKD）或 eGFR 减半的风险为 26%。本研究旨在收集我们中心 20 多年来的 IgAN 患者综合数据集，提供真实世界的数据，描述结局并确定免疫抑制治疗的效果。
设计、地点、参与者和测量：确定了我们中心 20 多年来经活检证实的 IgAN 患者。排除后，总队列大小为 401 例。收集的数据与（i）基线人口统计学资料、（ii）实验室和尿液结果、（iii）组织学数据和（iv）开始肾脏替代治疗（RRT）和死亡的结局相关。
中位年龄为 45.0 岁，男性占 69.6%，高血压占 57.6%；20.4%接受免疫抑制治疗，29.7%进展为 RRT，19.7%死亡，中位随访时间为 51 个月。基线 eGFR 为 46.7ml/min/1.73m2，基线 uPCR 为 183mg/mmol。eGFR 下降的中位速率为-1.31ml/min/1.73m2/年。MEST-C 评分较高的患者结局较差。免疫抑制治疗与蛋白尿改善率增加相关，但与 RRT 或死亡率降低无关。免疫抑制治疗效果较好的因素包括女性；年龄、血压和 T 评分较低；eGFR 较高；和 ACEi/ARB 治疗。
多种临床和组织学因素在确定 IgAN 进展风险方面很重要。治疗干预，特别是免疫抑制治疗，应根据这些因素个体化，并指导治疗。
