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Remission of Proteinuria Improves Prognosis in IgA Nephropathy

Heather N. Reich^*, Stéphan Troyanov, James W. Scholey^*, Daniel C. Cattran^* for the Toronto Glomerulonephritis Registry

^* Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, and Department of Medicine, Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada

Correspondence: Dr. Heather Reich, c/o The Toronto Glomerulonephritis Registry, Toronto General Hospital, 12EN-228, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. Phone: 416-340-4187; Fax: 416-340-3714; E-mail: h.reich{at}utoronto.ca

Received for publication May 1, 2007. Accepted for publication July 4, 2007.

Proteinuria has been shown to be an adverse prognostic factor in IgA nephropathy. The benefit of achieving a partial remission of proteinuria, however, has not been well described. We studied 542 patients with biopsy-proven primary IgA nephropathy in the Toronto Glomerulonephritis Registry and found that glomerular filtration rate (GFR) declined at –0.38 ± 0.61 ml/min per 1.73 m²/mo overall, with 30% of subjects reaching end-stage renal disease. Multivariate analysis revealed that proteinuria during follow-up was the most important predictor of the rate of GFR decline. Among the 171 patients with <1 g/d of sustained proteinuria, the rate of decline was 90% slower than the mean rate. The rate of decline increased with the amount of proteinuria, such that those with sustained proteinuria >3 g/d (n = 121) lost renal function 25-fold faster than those with <1 g/d. Patients who presented with 3 g/d who achieved a partial remission (<1 g/d) had a similar course to patients who had 1 g/d throughout, and fared far better than patients who never achieved remission. These results underscore the relationship between proteinuria and prognosis in IgA nephropathy and establish the importance of remission.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673