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Lower baseline eGFR levels and IgA nephropathy prediction tool

IgA nephropathy (IgAN) is the most common type of glomerulonephritis worldwide. Heterogeneous clinical course and ethnic variations are prominent features of the disease. 30%–40% of patients progress to end-stage kidney disease (ESKD) in 20 years. Risk stratification is an important part of patient examination to identify high-risk patients who may benefit from immunosuppressive medication to delay progression. Recently, the international risk prediction model of IgAN was externally validated by large independent cohorts. We used IgAN prediction tool (IgAN-PT) to calculate the predicted risk of our patients. IgAN-PT was applied to 74 patients [58.1% male, median age: 36 (30–44), mean follow-up 47.8 ± 21.9 months] to estimate the probability of disease progression. The study endpoint was progression to ESKD or ≥ 50% reduction in estimated glomerular filtration rate (eGFR). At diagnostic biopsy, median serum creatinine, eGFR and urine protein-creatinine ratio were 1.3 (1.07–1.8) mg/dl, 58.5 (42.25– 86.25) ml/min/1.73 m and 1.55 (1.04–2.5) g/g, respectively. Oxford classification scores were detailed in Table 1. Prior or at the time of biopsy, 65 patients (87.8%) had used angiotensin converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers, while five patients (6.7%) had received immunosuppressive agents. During follow-up, all patients were treated with ACEi/ARBs if tolerated and 29 (39.2%) received immunosuppressive therapy. Study endpoint developed in 22 patients (29.7%). However, IgAN-PT estimates were 8.5% (5.95–20.1) in these 22 patients and the estimates were not different compared with patients who did not reach the endpoint [8.25% (3.62–13.42)] (p = .388). In this small patient group, IgAN-PT did not predict the endpoint (HR 0.987, 95% CI 0.962–1.012, p = .299). Multivariate analysis revealed eGFR at biopsy (HR 0.974, 95% CI 0.951–0.997, p = .028) and proportion of global sclerotic glomeruli (HR 1.019, 95% CI 1.000–1.037, p = .046) as predictors of endpoint. Our group resembles the validation cohorts by means of age, sex, follow-up time and proteinuria but differs by lower levels of eGFR. The number of patients is limited to draw conclusions; however, our results suggest that detailed assessment of patients with IgAN and stage 3 and/or 4 chronic kidney disease in previous validation studies may help the clinical usefulness of IgAN-PT in patients with lower eGFR.