Wang Siqing, Zhou Huan, Dong Lingqiu, Qin Wei
Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
Front Med (Lausanne). 2025 Feb 25;12:1530312. doi: 10.3389/fmed.2025.1530312. eCollection 2025.
Immunoglobulin A nephropathy (IgAN), a common primary glomerulonephritis worldwide, has been investigated, and complex factors are involved in disease progression. A group of evidence emerged that nutrition status plays a nonsubstitutable role in the management of chronic kidney disease. Meanwhile, a novel marker of nutrition and inflammation, the prognostic nutritional index (PNI), has been studied in various diseases. Whether PNI can predict the renal outcome of patients with IgAN remains unclear. Thus, we aimed to evaluate the relationships between PNI and clinicopathologic features, renal progression and renal prognosis in patients with IgAN.
A total of 1,377 patients with biopsy-proven IgAN were recruited for this retrospective study. All patients were divided into two groups based on the cutoff value of PNI: the high group (PNI ≥ 47.1, = 886) and the low group (PNI < 47.1, = 491). Our study endpoint was end-stage renal disease [estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m or performance of renal replacement therapy]. A correlation test was conducted to explore the relationship between PNI and other important clinicopathologic parameters. The predictive value was determined by the area under the receiver operating characteristic curve (AUROC). Kaplan-Meier and Cox proportional hazards analyses were performed to assess the value of PNI in predicting renal progression and prognosis.
The correlation test revealed that PNI was positively associated with eGFR ( = 0.16, < 0.001) and negatively related to 24-h proteinuria ( = -0.387, < 0.001). Multivariate Cox regression analysis indicated that low PNI was an independent risk factor for IgAN patients even after adjusting for important clinical and pathological parameters (HR, 0.664; 95% CI, 0.443-0.994; = 0.047). Kaplan-Meier analysis showed that low PNI was significantly correlated with severe renal outcome in patients with IgAN ( < 0.001). Moreover, the subgroup analyses of Kaplan-Meier survival demonstrated that low PNI predicted severe renal prognosis in different types of IgAN patients when considering the level of glomerular filtration rate, 24 h proteinuria and hemoglobin.
PNI is associated with renal function and pathologic lesions in IgAN patients and could be a novel marker for the evaluation of renal progression and prognosis.
免疫球蛋白A肾病（IgAN）是全球常见的原发性肾小球肾炎，其发病机制已得到研究，疾病进展涉及多种复杂因素。有证据表明，营养状况在慢性肾脏病的管理中起着不可替代的作用。同时，一种新的营养与炎症标志物——预后营养指数（PNI），已在多种疾病中得到研究。PNI是否能预测IgAN患者的肾脏结局尚不清楚。因此，我们旨在评估PNI与IgAN患者临床病理特征、肾脏进展及肾脏预后之间的关系。
本回顾性研究共纳入1377例经活检证实为IgAN的患者。根据PNI的临界值将所有患者分为两组：高分组（PNI≥47.1，n = 886）和低分组（PNI < 47.1，n = 491）。我们的研究终点是终末期肾病[估计肾小球滤过率（eGFR）<15 mL/min/1.73 m²或进行肾脏替代治疗]。进行相关性检验以探讨PNI与其他重要临床病理参数之间的关系。通过受试者操作特征曲线下面积（AUROC）确定预测价值。采用Kaplan-Meier法和Cox比例风险分析评估PNI在预测肾脏进展和预后方面的价值。
相关性检验显示，PNI与eGFR呈正相关（r = 0.16，P < 0.001），与24小时蛋白尿呈负相关（r = -0.387，P < 0.001）。多因素Cox回归分析表明，即使在调整重要临床和病理参数后，低PNI仍是IgAN患者的独立危险因素（HR，0.664；95%CI，0.443 - 0.994；P = 0.047）。Kaplan-Meier分析显示，低PNI与IgAN患者的严重肾脏结局显著相关（P < 0.001）。此外，Kaplan-Meier生存亚组分析表明，在考虑肾小球滤过率、24小时蛋白尿和血红蛋白水平时，低PNI可预测不同类型IgAN患者的严重肾脏预后。
PNI与IgAN患者的肾功能和病理损害相关，可能是评估肾脏进展和预后的新标志物。
