Biblioteca Hospital 12 de Octubre
Huerta Arroyo, Ana María

Predictors of outcome for severe IgA nephropathy in a multi-ethnic US cohort. [artículo] - Clinical nephrology, 2015 - 84(3):145-55.

Formato Vancouver:
Arroyo AH, Bomback AS, Butler B, Radhakrishnan J, Herlitz L, Stokes MB et al. Predictors of outcome for severe IgA Nephropathy in a multi-ethnic U.S. cohort. Clin Nephrol. 2015 Sep;84(3):145-55.


PMID: 26226949

Contiene 42 referencias

Background: Although IgA nephropathy (IgAN) is the leading cause of glomerulonephritis worldwide, there are few large cohorts representative of U.S.
Populations: Prognosis remains challenging, particularly as more patients are treated with RAAS blockade and immunosuppression.
Methods: We analyzed a retrospective cohort of IgAN patients followed at Columbia University Medical Center from 1980 to 2010. We evaluated two outcomes - halving of eGFR and ESRD - using three proportional hazards models: 1) a model with only clinical parameters, 2) a model with only histopathologic parameters, and 3) a model combining clinical and histopathologic parameters.
Results: Of 154 patients with biopsy-proven IgAN, 126 had follow-up data available and 93 had biopsy slides re-read. Median follow-up was 47 months. The cohort was 64% male, 60% white, and the average age was 34 years at diagnosis. Median (IQR) eGFR and proteinuria at diagnosis were 64.1 (38.0 - 88.7) mL/min/1.73 m2 and 2.7 (1.3 - 4.5) g/day. Over 90% of subjects were treated with RAAS blockade, and over 66% received immunosuppression. In the clinical parameters-only model, baseline eGFR and African-American race predicted both halving of eGFR and ESRD. In the histopathologic parameters-only model, no parameter significantly predicted outcome. In the combined model, baseline eGFR remained the strongest predictor of both halving of eGFR (p = 0.03) and ESRD (p = 0.001), while the presence of IgG by immunofluorescence microscopy also predicted progression to ESRD.
Conclusion: In this diverse U.S. IgAN cohort in which the majority of patients received RAAS blockade and immunosuppression, baseline eGFR, African-American race, and co-staining of IgG predicted poor outcome.

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