IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. We present relationships among proteinuria, eGFR slope, and lifetime risks for kidney failure.
The IgA nephropathy cohort (2299 adults and 140 children) of the UK National Registry of Rare Kidney Diseases (RaDaR) was analyzed. Patients enrolled had a biopsy-proven diagnosis of IgA nephropathy plus proteinuria >0.5 g/d or eGFR <60 ml/min per 1.73 m2. Incident and prevalent populations and a population representative of a typical phase 3 clinical trial cohort were studied. Analyses of kidney survival were conducted using Kaplan–Meier and Cox regression. eGFR slope was estimated using linear mixed models with random intercept and slope.
The median (Q1, Q3) follow-up was 5.9 (3.0, 10.5) years; 50% of patients reached kidney failure or died in the study period. The median (95% confidence interval [CI]) kidney survival was 11.4 (10.5 to 12.5) years; the mean age at kidney failure/death was 48 years, and most patients progressed to kidney failure within 10–15 years. On the basis of eGFR and age at diagnosis, almost all patients were at risk of progression to kidney failure within their expected lifetime unless a rate of eGFR loss ≤1 ml/min per 1.73 m2per year was maintained. Time-averaged proteinuria was significantly associated with worse kidney survival and more rapid eGFR loss in incident, prevalent, and clinical trial populations. Thirty percent of patients with time-averaged proteinuria of 0.44 to <0.88 g/g and approximately 20% of patients with time-averaged proteinuria <0.44 g/g developed kidney failure within 10 years. In the clinical trial population, each 10% decrease in time-averaged proteinuria from baseline was associated with a hazard ratio (95% CI) for kidney failure/death of 0.89 (0.87 to 0.92).
Outcomes in this large IgA nephropathy cohort are generally poor with few patients expected to avoid kidney failure in their lifetime. Significantly, patients traditionally regarded as being low risk, with proteinuria <0.88 g/g (<100 mg/mmol), had high rates of kidney failure within 10 years.

David Pitcher

Fiona Braddon

Bruce Hendry

Alex Mercer

Kate Osmaston

Moin A. Saleem

Retha Steenkamp

Katie Wong

A. Neil Turner

Kaijun Wang

Daniel P. Gale

Jonathan Barratt

Clinical Journal of the American Society of Nephrology

CJASN 文章的目标是快速有效地传达肾脏病学临床和转化研究中最重要的进展，包括研究方法和护理提供的创新；将这些进展置于未来研究方向和患者护理的背景中；并成为可能影响肾脏病临床实践的一个重要问题，尤其是在美国。

The Clinical Journal of the American Society of Nephrology aims to rapidly and effectively communicate the most significant advancements in clinical and translational research in nephrology. The articles cover innovative research methods and care delivery, placing these advancements in the context of future research directions and patient care, striving to be a key reference that may influence clinical practice in nephrology, particularly in the United States.

《Clinical Journal of the American Society of Nephrology》旨在快速有效地传达肾脏病学领域内临床和转化研究的最新进展。这些文章不仅涵盖了研究方法和护理创新，还将这些进展置于未来研究方向和患者护理的背景中，力求成为影响肾脏病临床实践的重要参考，尤其是在美国。

CJASN

Long-Term Outcomes in IgA Nephropathy

IgA肾病的长期预后

Category	Quartile
医学	1
医学, 泌尿学与肾脏学	1

Long-Term Outcomes in IgA Nephropathy

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Journal Info

Category	Quartile
UROLOGY & NEPHROLOGY	1