PMID- 33831052
OWN - NLM
STAT- MEDLINE
DCOM- 20210920
LR  - 20240331
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 16
IP  - 4
DP  - 2021
TI  - Long term outcome of immunoglobulin A (IgA) nephropathy: A single center 
      experience.
PG  - e0249592
LID - 10.1371/journal.pone.0249592 [doi]
LID - e0249592
AB  - INTRODUCTION: IgA nephropathy (IgAN) has a heterogeneous presentation and the 
      progression to end stage renal disease (ESRD) is often influenced by 
      demographics, ethnicity, as well as choice of treatment regimen. In this study, 
      we investigated the long term survival of IgAN patients in our center and the 
      factors affecting it. METHODS: This study included all biopsy-proven IgAN 
      patients with >/= 1year follow-up. Patients with diabetes mellitus at diagnosis and 
      secondary IgAN were excluded. Medical records were reviewed for demographics, 
      clinical presentation, blood pressure, 24-hour urine protein, serum creatinine, 
      renal biopsy and treatment received. The primary outcome was defined as combined 
      event of 50% estimated glomerular filtration rate (eGFR) reduction or ESRD. 
      RESULTS: We included 130 (74 females; 56 males) patients of mean age 38.0 +/- 14.0 
      years and median eGFR of 75.2 (interquartile range (IQR) 49.3-101.4) 
      ml/min/1.73m2. Eighty-four (64.6%) were hypertensive at presentation, 35 (26.9%) 
      had nephrotic syndrome and 57 (43.8%) had nephrotic range proteinuria (NRP). 
      Median follow-up duration was 7.5 (IQR 4.0-13.0) years. It was noted that 18 
      (13.8%) developed ESRD and 34 (26.2%) reached the primary outcome. Annual eGFR 
      decline was -2.1 (IQR -5.3 to -0.1) ml/min/1.73m2/year, with median survival of 
      20 years. Survival rates from the combined event (50% decrease in eGFR or ESRD) 
      at 10, 20 and 30 years were 80%, 53% and 25%, while survival from ESRD were 87%, 
      73% and 65%, respectively. In the univariate analysis, time-average proteinuria 
      (hazard ratio (HR) = 2.41, 95% CI 1.77-3.30), eGFR <45ml/min/1.73m2 at biopsy (HR 
      = 2.35, 95% CI 1.03-5.32), hypertension (HR = 2.81, 95% CI 1.16-6.80), mean 
      arterial pressure (HR = 1.02, 95% CI 1.01-1.04), tubular atrophy/interstitial 
      fibrosis score (HR = 3.77, 95% CI 1.84-7.73), and cellular/fibrocellular crescent 
      score (HR = 2.44, 95% CI 1.19-5.00) were found to be significant. Whereas only 
      time-average proteinuria (TA-proteinuria) remained as a significant predictor in 
      the multivariate analysis (HR = 2.23, 95% CI 1.57-3.16). CONCLUSION: In our 
      cohort, TA-proteinuria was the most important predictor in the progression of 
      IgAN, irrespective of degree of proteinuria at presentation.
FAU - Mohd, Rozita
AU  - Mohd R
AD  - Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala 
      Lumpur, Malaysia.
FAU - Mohammad Kazmin, Nur Ezzaty
AU  - Mohammad Kazmin NE
AUID- ORCID: 0000-0002-9797-3735
AD  - Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, 
      Negeri Sembilan, Malaysia.
FAU - Abdul Cader, Rizna
AU  - Abdul Cader R
AD  - Park City Medical Centre, Kuala Lumpur, Malaysia.
FAU - Abd Shukor, Nordashima
AU  - Abd Shukor N
AD  - Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 
      Kuala Lumpur, Malaysia.
FAU - Wong, Yin Ping
AU  - Wong YP
AUID- ORCID: 0000-0003-4897-9927
AD  - Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 
      Kuala Lumpur, Malaysia.
FAU - Shah, Shamsul Azhar
AU  - Shah SA
AD  - Department of Community Health, Faculty of Medicine, Universiti Kebangsaan 
      Malaysia, Kuala Lumpur, Malaysia.
FAU - Alfian, Nurwardah
AU  - Alfian N
AD  - Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 
      Kuala Lumpur, Malaysia.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20210408
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Adult
MH  - Creatinine/*blood
MH  - Disease Progression
MH  - Female
MH  - Follow-Up Studies
MH  - *Glomerular Filtration Rate
MH  - Glomerulonephritis, IGA/blood/drug therapy/*pathology
MH  - Humans
MH  - Male
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Rate
PMC - PMC8031432
COIS- The authors have declared that no competing interests exists.
EDAT- 2021/04/09 06:00
MHDA- 2021/09/21 06:00
PMCR- 2021/04/08
CRDT- 2021/04/08 17:27
PHST- 2020/11/24 00:00 [received]
PHST- 2021/03/22 00:00 [accepted]
PHST- 2021/04/08 17:27 [entrez]
PHST- 2021/04/09 06:00 [pubmed]
PHST- 2021/09/21 06:00 [medline]
PHST- 2021/04/08 00:00 [pmc-release]
AID - PONE-D-20-36829 [pii]
AID - 10.1371/journal.pone.0249592 [doi]
PST - epublish
SO  - PLoS One. 2021 Apr 8;16(4):e0249592. doi: 10.1371/journal.pone.0249592. 
      eCollection 2021.