MO222: Prognostic Factors for CKD Progression in Patients with IGA Nephropathy

Abstract BACKGROUND AND AIMS IgA nephropathy is a progressive renal disease with up to 30% of patients reaching end stage kidney disease within 10–20 years. The aim of this study was to analyze the phenotype of patients with IgA nephropathy followed in a tertiary renal center and explore its association with renal survival. METHOD All records from patients with a biopsy-proven IgA nephropathy were retrospectively assessed. Demographic and clinical characteristics were recorded for each patient at baseline and during follow-up. The transition to the next stage of chronic kidney disease (CKD) by the end of the follow-up was considered as progression of CKD. RESULTS We included 53 patients with IgA nephropathy, 35 (66.04%) males and 18 (33.96%) females. The mean age at the time of diagnosis was 46 (±16.92) years old and the median follow-up time was 4.75 (2–11.75) years. Median eGFR using the CKD-EPI creatinine equation was 63 (32–86) mL/min/1.73 m2 and the median proteinuria level was 1890 (830–3500) mg/24 h. At the time of diagnosis, 30.19% of patients presented with macroscopic hematuria, 24.53% with upper respiratory infection, 11.32% with rapidly progressive glomerulonephritis and 60.38% with hypertension. The majority (86.7%) of patients were treated with renin–angiotensin–aldosterone system (RAAS) blockade, while 34 patients (64.15%) received immunosuppression. Eighteen patients (33.96%) were treated with a 6-month corticosteroid regimen (Pozzi protocol), seven (13.21%) with cyclophosphamide, four (7.55%) with azathioprine and eleven (20.75%) with mycophenolate mofetil, while seven patients (13.21%) received repeated therapeutic regimens. The level of proteinuria (g/24h) and the need for repeated therapy were prognostic factors of CKD progression at the end of the follow-up (HR 1.22, P = .01 and HR 2.90, P = .04, respectively). In age-adjusted multivariable analysis only the need for repeated therapy remained statistically significant. The patients who needed repeated treatment had a 4.45-fold risk for CKD progression compared with patients of the same age, who did not need repeated therapy (HR 4.45, P = .02). CONCLUSION High grade proteinuria and mainly the need for repeated treatment are poor prognostic factors of CKD progression during the long-term follow up of patients with IgA nephropathy.