scholarly journals The association of microhematuria with mesangial hypercellularity, endocapillary hypercellularity, crescent score and renal outcomes in immunoglobulin A nephropathy

2019 ◽  
Author(s):  
Shane A Bobart ◽  
Mariam P Alexander ◽  
Khaled Shawwa ◽  
Lisa E Vaughan ◽  
Ranine Ghamrawi ◽  
...  
Keyword(s):  
Estimated Glomerular Filtration Rate ◽  
Independent Predictor ◽  
Immunoglobulin A ◽  
Immunoglobulin A Nephropathy ◽  
High Power Field ◽  
Surrogate Outcome ◽  
Mesangial Hypercellularity ◽  
Egfr Decline ◽  
Endocapillary Hypercellularity

Abstract Background Microhematuria is common in immunoglobulin A nephropathy (IgAN). However, current prognostication is based on proteinuria and mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, tubulointerstitial fibrosis and crescent (MEST-C) scores. Methods In this retrospective study, we evaluated whether MEST-C score components are associated with the presence of microhematuria at biopsy and whether the degree of microhematuria during follow-up is associated with change in estimated glomerular filtration rate (eGFR), after adjusting for clinical and histological parameters. We identified 125 patients with biopsy-proven IgAN and MEST-C scoring who were not on immunosuppressive therapy at biopsy. Microhematuria was defined as ≥3 red blood cells (RBCs)/high-power field (hpf). Results Of the 125 patients, 97 had microhematuria at baseline and were more likely to have M1, E1 and C ≥ 1 lesions (P < 0.05 for all) compared with patients without microhematuria. Of the 125 patients, 72 had follow-up data available. An increase in the degree of microhematuria was significantly associated with an eGFR decline of −0.81 mL/min/1.73 m2 [95% confidence interval (CI) −1.44 to −0.19, P = 0.01], after adjusting for follow-up time, proteinuria and T score. Severe microhematuria (≥21 RBCs/hpf) was associated with an even larger decline in eGFR (−3.99 mL/min/1.73 m2; 95% CI −6.9411 to −1.0552, P = 0.008), after similar adjustments. Conclusion Degree of microhematuria during follow-up is an independent predictor of eGFR decline after adjusting for clinical and histological parameters. Therefore, monitoring the degree of microhematuria as well as proteinuria is important when evaluating patients with IgAN. Additional studies using improvement in microhematuria as a primary surrogate outcome are needed.

scholarly journals Choice of endpoint in kidney outcome trials: considerations from the EMPA-REG OUTCOME® trial

2019 ◽  
Vol 35 (12) ◽  
pp. 2103-2111 ◽  
Author(s):  
Vlado Perkovic ◽  
Audrey Koitka-Weber ◽  
Mark E Cooper ◽  
Guntram Schernthaner ◽  
Egon Pfarr ◽  
...  
Keyword(s):  
Estimated Glomerular Filtration Rate ◽  
Standard Of Care ◽  
End Stage Kidney Disease ◽  
High Cardiovascular Risk ◽  
End Stage ◽  
Post Hoc ◽  
Event Rates ◽  
Egfr Decline

Abstract Background Doubling of serum creatinine [equivalent to 57% reduction in estimated glomerular filtration rate (eGFR)] is an established surrogate for end-stage kidney disease (ESKD); however, this endpoint necessitates lengthy follow-up and large sample sizes in clinical trials. We explored whether alternative eGFR decline thresholds provide more feasible surrogate kidney endpoints. Methods The study involved post hoc analysis of the EMPA-REG OUTCOME® trial. Adults with type 2 diabetes, high cardiovascular risk and eGFR ≥30 mL/min/1.73 m2 were assigned empagliflozin 10 mg or 25 mg (n = 4687) or placebo (n = 2333), on top of standard of care. We assessed composite endpoints incorporating different eGFR decline thresholds (≥30, ≥40, ≥50 or ≥57%) combined with initiation of renal replacement therapy (RRT) or renal death. This trial is registered with ClinicalTrials.gov (NCT01131676). Results Empagliflozin versus placebo significantly lowered the risk of decline in eGFR for each threshold listed above, combined with initiation of RRT or renal death, ranging from a hazard ratio (HR) of 0.81 [95% confidence interval (CI) 0.72–0.91] for endpoints based on 30% eGFR decline to an HR of 0.37 (0.23–0.61) for endpoints based on 57% eGFR decline. Lower thresholds (e.g. 30%) were associated with higher event rates but weaker treatment effects. The time to the 95% CI of the HR falling to <1.0 decreased with increasing eGFR threshold. Conclusions The composite of 40% decline in eGFR, ESKD or renal death appears to provide reliable results similar to the traditional 57% decline in eGFR.

scholarly journals Severe Decline of Estimated Glomerular Filtration Rate Associates with Progressive Cognitive Deterioration in the Elderly: A Community-Based Cohort Study

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Yi-Chi Chen ◽  
Shuo-Chun Weng ◽  
Jia-Sin Liu ◽  
Han-Lin Chuang ◽  
Chih-Cheng Hsu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
The Elderly ◽  
Percentage Change ◽  
Cognitive Deterioration ◽  
Egfr Decline

Abstract Cognitive dysfunction is closely related to aging and chronic kidney disease (CKD). However, the association between renal function changes and the risk of developing cognitive impairment has not been elucidated. This longitudinal cohort study was to determine the influence of annual percentage change in estimated glomerular filtration rate (eGFR) on subsequent cognitive deterioration or death of the elderly within the community. A total of 33,654 elders with eGFR measurements were extracted from the Taipei City Elderly Health Examination Database. The Short Portable Mental Status Questionnaire was used to assess their cognitive progression at least twice during follow-up visits. Multivariable Cox regression models were used to estimate the hazard ratio (HR) for cognitive deterioration or all-cause mortality with the percentage change in eGFR. During a median follow-up of 5.4 years, the participants with severe decline in eGFR (>20% per year) had an increased risk of cognitive deterioration (HR, 1.33; 95% confidence interval [CI], 1.08–1.72) and the composite outcome (HR, 1.17; 95% CI, 1.03–1.35) when compared with those who had stable eGFR. Severe eGFR decline could be a possible predictor for cognitive deterioration or death among the elderly. Early detection of severe eGFR decline is a critical issue and needs clinical attentions.

Plasma fractalkine levels are associated with renal inflammation and outcomes in immunoglobulin A nephropathy

2018 ◽  
Vol 34 (9) ◽  
pp. 1549-1558 ◽  
Author(s):  
Ran Luo ◽  
Shui-Ming Guo ◽  
Yue-Qiang Li ◽  
Yi Yang ◽  
Meng-Lan Li ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Creatinine Level ◽  
Mesangial Cells ◽  
Immunoglobulin A ◽  
Renal Tissue ◽  
Chinese Patients ◽  
Renal Outcome ◽  
Immunoglobulin A Nephropathy ◽  
Urine Protein ◽  
Mesangial Hypercellularity

Abstract Background A recognized noninvasive biomarker to improve risk stratification of immunoglobulin A nephropathy (IgAN) patients is scarce. Fractalkine has been shown to play a key role in glomerular disease as chemoattractant, adhesion and even fibrosis factor. The current study assessed the possibility of plasma fractalkine as a novel biomarker in IgAN patients. Methods Plasma fractalkine was measured in 229 patients with renal biopsy consistent IgAN from 2012 to 2014, and clinical, pathological and prognostic relationships were analyzed. Results The plasma fractalkine levels in IgAN patients were significantly correlated with the creatinine level and 24-h urine protein by both univariate and multivariate analysis. Mesangial hypercellularity was still significantly correlated with the plasma fractalkine levels even after adjustment for other potential predictor variables by multivariate analysis. In addition, the counts of CD20+ B cells or CD68+ macrophage in renal biopsies of IgAN patients were significantly correlated with the plasma fractalkine levels, but not CD4+ and CD8+ T cells. Finally, we concluded that patients with higher plasma fractalkine levels had higher risk of poor renal outcome compared with those with lower plasma fractalkine levels. No association was observed between the CX3CR1 polymorphisms and clinical parameters including plasma fractalkine levels and prognosis. Recombinant fractalkine induced mesangial cells extracellular matrix synthesis and promoted the migration of microphage cells RAW264.7. Conclusions Plasma fractalkine levels were associated with creatinine level, 24-h urine protein, mesangial hypercellularity pathological damage, the CD68+ macrophage and CD20+ B cell infiltration in renal tissue and renal outcome in IgAN patients. Plasma fractalkine might be a potential prognosis novel predictor in Chinese patients with IgAN.

scholarly journals Renal function of bladder cancer patients after urinary diversion by ileal conduit in Rajavithi Hospital

2021 ◽  
Vol 42 (1) ◽  
pp. 34-39
Author(s):  
Sittichon Suriyawongkul ◽  
◽  
Chawawat Gosrisirikul ◽  
Vorapot Choonhaklai ◽  
Tanet Thaidumrong ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Urinary Tract ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Ileal Conduit ◽  
Upper Urinary Tract ◽  
Egfr Decline

Objectives: Our objectives were to evaluate the long-term renal function after radical cystectomy (RC) and ileal conduit diversion (ICD) and to analyze year-by-year the estimated glomerular filtration rate (eGFR) and morphologic upper urinary tract changes. Materials and Methods: We retrospectively identified 214 patients who had undergone RC and ICD from 2012 to 2018, with regular postoperative follow-up visits. The eGFR was calculated using the Modification of Diet in Renal Disease equation at baseline and during follow-up. A renal function decrease was defined as a greater than 10 mL/min/1.73 m2 reduction in the estimated glomerular filtration rate. Results: The median follow-up period after RC was 24 months (range, 6-60 months). The median eGFR decreased from 64 mL/min/1.73 m2 (range, 9-125 mL/min/1.73 m2) to 61.5 mL/min/1.73 m2 (range, 8-125 mL/min/1.73 m2). A decline in renal function occurred during the first postoperative years (2.74 mL/ min/1.73 m2 and 3.95 mL/min/1.73 m2 in the first and second year, respectively), with a slight decrease in the subsequent years. The strongest predictor of an eGFR decline was CKD stage 1 or 2 (> 60 mL/min/1.73 m2). Urinary obstruction was diagnosed in 6 patients (2.8%). Among the patients who underwent prompt interventional treatment, we did not find any association with the eGFR decline. Conclusion: Patients with urinary ICD have a lifelong risk of chronic kidney disease. Regular monitoring of renal function and the morphologic upper urinary tract will permit early diagnosis and treatment of modifiable factors, avoiding irreversible kidney damage.

scholarly journals Proteinuria and cholesterol reduction are independently associated with less renal function decline in statin-treated patients; a post hoc analysis of the PLANET trials

2018 ◽  
Vol 34 (10) ◽  
pp. 1699-1706 ◽  
Author(s):  
Nienke M A Idzerda ◽  
Michelle J Pena ◽  
Hans-Henrik Parving ◽  
Dick de Zeeuw ◽  
Hiddo J L Heerspink
Keyword(s):  
Renal Function ◽  
Estimated Glomerular Filtration Rate ◽  
Individual Variability ◽  
Cholesterol Reduction ◽  
The Individual ◽  
Induced Changes ◽  
Post Hoc ◽  
Progressive Renal Disease ◽  
Egfr Decline

Abstract Background Statins have shown multiple effects on different renal risk factors such as lowering of total cholesterol (TC) and lowering of urine protein:creatinine ratio (UPCR). We assessed whether these effects of statins vary between individuals, the extent of discordance of treatment effects on both TC and UPCR within an individual, and the association of responses in TC and UPCR with estimated glomerular filtration rate (eGFR) decline. Methods The PLANET I and II (Renal effects of Rosuvastatin and Atorvastatin in Patients Who Have Progressive Renal Disease) trials examined effects of atorvastatin and rosuvastatin on proteinuria and renal function in patients with proteinuria. We post hoc analysed 471 therapy-adherent proteinuric patients from the two trials and assessed the individual variability in UPCR and TC response from 0 to 14 weeks and whether these responses were predictive of eGFR decline during the subsequent 9 months of follow-up. Results UPCR and TC response varied between individuals: mean UPCR response was −1.3% (5th–95th percentile −59.9 to 141.8) and mean TC response was −93.9 mg/dL (−169.1 to −26.9). Out of 471 patients, 123 (26.1%) showed a response in UPCR but not in TC, and 96 (20.4%) showed a response in TC but not in UPCR. eGFR (mL/min/1.73 m2) did not decrease significantly from baseline in both UPCR responders [0.4; 95% confidence interval (CI) −1.6 to 0.9; P = 0.54] and TC responders (0.3; 95% CI −1.8 to 1.1; P = 0.64), whereas UPCR and TC non-responders showed a significant decline in eGFR from baseline (1.8; 95% CI 0.6–3.0; P = 0.004 and 1.7; 95% CI 0.5–2.9; P = 0.007, respectively). A lack of response in both parameters resulted in the fastest rate of eGFR decline (2.1; 95% CI 0.5–3.7; P = 0.01). These findings were not different for rosuvastatin or atorvastatin. Conclusions Statin-induced changes in cholesterol and proteinuria vary between individuals and do not run in parallel within an individual. The initial fall in cholesterol and proteinuria is independently associated with a reduction in eGFR decline. This highlights the importance of monitoring both cholesterol and proteinuria after initiating statin therapy.

Natural history of immunoglobulin A nephropathy and predictive factors of prognosis: A long-term follow up of 204 cases in China

Nephrology ◽  
2008 ◽  
Vol 13 (3) ◽  
pp. 242-246 ◽  
Author(s):  
JICHENG LV ◽  
HONG ZHANG ◽  
YANG ZHOU ◽  
GUANGTAO LI ◽  
WANZHONG ZOU ◽  
...  
Keyword(s):  
Natural History ◽  
Predictive Factors ◽  
Immunoglobulin A ◽  
Immunoglobulin A Nephropathy ◽  
Long Term Follow Up ◽  
History Of

scholarly journals Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update

2018 ◽  
Vol 35 (6) ◽  
pp. 1002-1009 ◽  
Author(s):  
Rosanna Coppo ◽  
Graziella D'Arrigo ◽  
Giovanni Tripepi ◽  
Maria Luisa Russo ◽  
Ian S D Roberts ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Validation Study ◽  
Kidney Failure ◽  
Interstitial Fibrosis ◽  
Immunoglobulin A ◽  
Immunoglobulin A Nephropathy ◽  
Oxford Classification ◽  
The Oxford Classification

Abstract Background It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up. Methods In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1–10.8)]. Results In this extended analysis, M1, S1 and T1–T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%). Conclusion Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.

scholarly journals Utility of remission criteria for the renal prognosis of IgA nephropathy

2021 ◽  
Author(s):  
Keiichi Matsuzaki ◽  
Hitoshi Suzuki ◽  
Tetsuya Kawamura ◽  
Yasuhiko Tomino ◽  
Yusuke Suzuki
Keyword(s):  
Immunoglobulin A ◽  
University Hospital ◽  
Secondary Outcome ◽  
Primary Study ◽  
High Power Field ◽  
Dipstick Test ◽  
Remission Criteria ◽  
Renal Prognosis ◽  
Red Blood Cell Count ◽  
Egfr Decline

Abstract Background Novel criteria for the remission of Immunoglobulin A nephropathy (IgAN) based on an opinion survey of Japanese nephrologists and literature review were proposed in 2013. This single-center, longitudinal retrospective cohort study was conducted to validate this criteria. Methods Present study included the IgAN patients diagnosed between 2001 and 2005 in the Juntendo University Hospital. Remission of hematuria was defined as three consecutive dipstick test results of ( −) to ( ±) or a red blood cell count < 5 in urinary sediment per high-power field during at least 6 months. Remission of proteinuria was defined as three consecutive dipstick results of ( −) to ( ±) during at least 6 months. We categorized four groups according to the remission status which was assessed 2 years after the renal biopsy. The primary outcome was a 50% increase in the serum creatinine over the baseline. We evaluated the slope of eGFR decline (mL/min/1.73 m2/year) and a decrease in the eGFR of 30% from baseline eGFR as the secondary outcome, respectively. Results A total of 74 patients (male: 47.3%, median age: 30 years) were included and were followed for a median of 86.5 months. During the period, forty-one patients achieved neither remission of proteinuria nor hematuria (NR). Twelve patients met the primary study outcome. A survival analysis revealed that the NR had the worst prognosis and the steepest slope of eGFR decline. Conclusion Although further validation in a large cohort is necessary, these novel remission criteria for IgAN patients appear to predict the renal prognosis.

Sign in / Sign up

Export Citation Format

Share Document