Liječnički vjesnik, Vol. 146 No. 5-6, 2024.
Izvorni znanstveni članak
https://doi.org/10.26800/LV-146-5-6-3
Outcomes of patients with IgA nephropathy according to treatment modality
Ines Bosnić Kovačić
*
Bojana Maksimović
Željka Jureković
Lada Zibar
Bojana Šimunov
Branislav Čingel
Snježana Šulc
Ivan Margeta
Ksenija Vučur Šimić
Danica Galešić Ljubanović
Petar Šenjug
Vanja Ivković
Mladen Knotek
Mario Laganović
* Autor za dopisivanje.
Sažetak
Introduction: IgA nephropathy (IgAN) exhibits variable clinical course and prognosis. To assess prognosis International IgAN Prediction (IgAN-PT) score was developed, and predicts the risk of a 50 % decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease after biopsy. Only patients with a high risk of progression despite three months of optimized supportive care are considered for a six-month course of glucocorticoid therapy. Aim: of this study was to investigate which patients were more likely to receive immunosuppressive therapy (IS) and renal outcomes in patients treated with IS. Patients and methods: The retrospective cohort study included 48 patients (33 male), median age 50 years (interquartile range IQR 35–59), median follow-up 43 months (IQR 18–54), treated at Clinical Hospital Merkur for a newly diagnosed idiopathic IgAN from 2012 to 2021 Results: Seventeen patients were treated with IS. They had more frequently mesangial lesions (M) (82 % vs. 54 %, p=0.05), endocapillary hypercellularity (E) (65 % vs. 21 %, p=0.004) and crescents (C) (41 % vs. 14 %, p=0.04). There was no difference in eGFR at biopsy (52 (IQR 38–81) vs. 46 (IQR 30–72) mL/min/1.73 m2, p<0.05), but patients treated with IS had better eGFR after 2-year follow-up (66 (IQR 37–97) vs. 34 (IQR 20–56) mL/min/1.73 m2, p=0.02). Urinary protein to creatinine ratio (uPCR) decreased after the treatment (at biopsy vs. end of follow-up, 106 (IQR 50–317) vs. 47(IQR 20–129) mg/mmol)). Still, there was no difference in baseline or end of follow-up
uPCR between patients receiving IS and not. IIgAN score decreased after the treatment (at biopsy vs. at 2-year follow- up (10.56 %±12.66 % vs. 8.45 %±9.22 %, p=0.01) without difference between those treated with IS and not. Conclusion: Patients with higher M, E and C score were more likely to be treated with IS, and had better eGFR after 2-year follow-up. uPCR and IIgAN score improved irrespective of the treatment modality.
Ključne riječi
GLOMERULONEPHRITIS, IGA – drug therapy, pathology; KIDNEY – pathology; RENAL INSUFFICIENCY, CHRONIC – etiology, pathology; PROTEINURIA; CREATININE – urine; GLOMERULAR FILTRATION RATE; IMMUNOSUPPRESSION THERAPY; ADRENAL CORTEX HORMONES – therapeutic use; BIOPSY; DISEASE PROGRESSION
Hrčak ID:
319959
URI
Datum izdavanja:
8.7.2024.
Posjeta: 0 *