Abstract
BACKGROUND: Primary IgA nephropathy (IgAN) is the most common form of idiopathic glomerulonephritis worldwide. Although most patients are able to achieve remission with the current therapy, a large number of patients will still progress to end-stage renal disease. This study aimed to evaluate kidney disease progression and the risk factors for progression in IgAN patients who achieved remission. METHODS: Patients from a prospective database with IgAN were included in this study. All the subjects had achieved a complete remission (CR) or partial remission (PR) following 6 months of therapy. Renal survival and the relationship between the clinical parameters and composite renal outcomes were assessed. RESULTS: The study comprised 878 IgAN patients recruited between January 2005 and December 2010. Overall, 632 patients were enrolled in this study. The data from the 369 patients who achieved remission were analyzed; the mean follow-up time was 49 months. The median serum creatinine (SCr) concentration at baseline was 91.3 μmol/L, and the time-averaged creatinine (TA-SCr) was 91.8 μmol/L. The mean serum albumin (ALB) level at baseline was 39.4 g/L, and the time-averaged serum albumin (TA-ALB) was 42.1 g/L. Multivariate Cox regression analyses revealed that the TA-ALB and TA-SCr levels were independently associated with the composite renal outcome. The patients with a TA-SCr value > 120 μmol/L and a TA-ALB level < 38 g/L were less likely to recover from renal progression. CONCLUSION: The strong predictive relationship of low TA-ALB and high TA-SCr levels with progression observed in this study suggests that TA-ALB may serve as a marker of the long-term renal prognosis of IgAN patients who have achieved remission.