Measures of Urinary Protein and Albumin in the Prediction of Progression of IgA Nephropathy

• Published in: Clinical journal of the American Society of Nephrology 2016-06, Vol.11 (6), p.947-955
• Main Authors: Zhao, Yan-Feng, Zhu, Li, Liu, Li-Jun, Shi, Su-Fang, Lv, Ji-Cheng, Zhang, Hong
• Format: Article
• Language: English
• Subjects: Adult; Albuminuria - urine; Creatinine - urine; Disease Progression; Female; Follow-Up Studies; Glomerular Filtration Rate; Glomerulonephritis, IGA - complications; Glomerulonephritis, IGA - physiopathology; Glomerulonephritis, IGA - urine; Humans; Kidney Failure, Chronic - etiology; Male; Middle Aged; Original; Predictive Value of Tests; Proteinuria - urine; Survival Rate; Young Adult
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/cjn.10150915

Proteinuria is an independent predictor for IgA nephropathy (IgAN) progression. Urine albumin-to-creatinine ratio (ACR), protein-to-creatinine ratio, and 24-hour urine protein excretion (UPE) are widely used for proteinuria evaluation in clinical practice. Here, we evaluated the association of these measurements with clinical and histologic findings of IgAN and explored which was the best predictor of IgAN prognosis. Patients with IgAN were followed up for ≥12 months, were diagnosed between 2003 and 2012, and had urine samples available (438 patients). Spot urine ACR, protein-to-creatinine ratio, and 24-hour UPE at the time of renal biopsy were measured on a Hitachi Automatic Biochemical Analyzer 7180 (Hitachi, Yokohama, Japan). In our patients, ACR, protein-to-creatinine ratio, and 24-hour UPE were highly correlated (correlation coefficients: 0.71-0.87). They showed good relationships with acknowledged markers reflecting IgAN severity, including eGFR, hypertension, and the biopsy parameter (Oxford severity of tubular atrophy/interstitial fibrosis parameter). However, only ACR presented with positive association with the Oxford segmental glomerulosclerosis/adhesion parameter and extracapillary proliferation lesions. The follow-up time was 37.0 (22.0-58.0) months, with the last follow-up on April 18, 2014. In total, 124 patients reached the composite end point (30% eGFR decline, ESRD, or death). In univariate survival analysis, ACR consistently had better performance than protein-to-creatinine ratio and 24-hour UPE as represented by higher area under the curve using time-dependent survival analysis. When adjusted for well known risk factors for IgAN progression, ACR was most significantly associated with the composite end point (hazard ratio, 1.56 per 1-SD change of standard normalized square root-transformed ACR; 95% confidence interval, 1.29 to 1.89; P