Predicting the risk for dialysis or death in IgA nephropathy

Area of Science:

• Nephrology
• Immunology
• Clinical Epidemiology

Background:

• Predicting long-term prognosis for IgA nephropathy (IgAN) patients on standard treatment is difficult.
• IgAN is a common primary glomerulonephritis with variable clinical courses.

Purpose of the Study:

• To develop and validate a simple scoring system for predicting renal outcomes in IgAN patients.
• To assess the association between baseline risk factors and the risk of end-stage renal disease or death.

Main Methods:

• Prospective cohort study of 332 biopsy-proven IgAN patients followed for an average of 13 years.
• Calculation of an Absolute Renal Risk (ARR) score based on diagnosis: hypertension, proteinuria (≥1 g/d), and severe pathology (global optical score ≥8).
• Analysis of cumulative incidence of death or dialysis stratified by ARR score.

Main Results:

• The ARR score significantly stratified patients' risk for dialysis or death (P < 0.0001).
• Cumulative incidence of death or dialysis at 20 years ranged from 4% (ARR=0) to 64% (ARR=3).
• Adequate control of hypertension and proteinuria reduced the risk of adverse renal outcomes.

Conclusions:

• The Absolute Renal Risk (ARR) score determined at diagnosis is a valuable tool for stratifying IgAN patients.
• This score aids in predicting the long-term risk of dialysis or death in IgAN.
• Management of hypertension and proteinuria is crucial for improving outcomes in IgAN.