Journal article
Proteinuria Trajectory and Disease Progression in Children and Adults with IgA Nephropathy/Vasculitis
Clinical journal of the American Society of Nephrology, Vol.20(7), pp.978-992
07/2025
DOI: 10.2215/CJN.0000000707
PMCID: PMC12262914
PMID: 40208688
Abstract
Identifying patients with IgA Nephropathy at risk for disease progression is critical for clinical decision making, risk-based patient counseling, and optimal enrollment of clinical trials.
Patients with IgA Nephropathy (IgAN) and IgA Vasculitis with Nephritis (IgAVN) were enrolled in CureGN, a multi-center observational cohort study. Children and adults were analyzed separately in four cohorts 1) full, 2) incident, 3) prevalent, and 4) histology. Groups were defined using latent class trajectory modeling using proteinuria measurements over two years. Linear mixed models were used to calculate predicted estimated glomerular filtration rate (eGFR) slope. In adults, Cox proportional hazard models were used to model time to kidney failure or 40% eGFR decline as a function of proteinuria trajectory group.
Of 919 individuals with IgAN/IgAVN enrolled into CureGN, 368 adults and 234 children were included in the analysis. In the full adult cohort, Group 1 had the lowest levels of proteinuria (IQR 0.1-0.4 g/g), while Groups 2 and 3 had intermediate and higher levels of proteinuria (IQR 0.5-1.5 and IQR 1.8-4.1 g/g, respectively). Average predicted time to eGFR less than 15 ml/min/1.73 m2 was >90, 16, and 8 years and >90, 67, 11 years for proteinuria trajectory groups 1, 2, and 3, in the full adult and pediatric cohorts, respectively. In adults, adjusting for age, eGFR at enrollment, immunosuppression exposure, and hypertension, Group 3 membership was associated with 3.13 (95% CI 1.84-5.33), 1.98 (95% CI 0.97-4.06), and 3.36 (95% CI 1.59-7.13) times higher hazard of progressing to a composite outcome compared to Group 2 membership in the full, prevalent and histology cohorts, respectively, but not associated with progression in the incident cohort.
Proteinuria trajectory is a major predictor of disease progression in patients with IgA nephropathy.
Details
- Title: Subtitle
- Proteinuria Trajectory and Disease Progression in Children and Adults with IgA Nephropathy/Vasculitis
- Creators
- Dorey A Glenn - University of North Carolina at Chapel HillAshley W Carver - University of North Carolina at Chapel HillMargaret E Helmuth - University of MichiganAbigail R Smith - Northwestern UniversityRichard A Lafayette - Stanford MedicinePrasanth Ravipati - University of Nebraska Medical CenterAndrea L Oliverio - University of MichiganDana V Rizk - University of Alabama at BirminghamJan Novak - University of Alabama at BirminghamFrancesca Lugani - Istituto Giannina GasliniSharon M Bartosh - University of Wisconsin–MadisonKrzysztof Mucha - Medical University of WarsawKrzysztof Kiryluk - Columbia UniversityManish K Saha - University of North Carolina at Chapel HillCynthia C Nast - Cedars-Sinai Medical CenterJean Hou - Cedars-Sinai Medical CenterLaura E Biederman - Nationwide Children's HospitalNidia Messias - Washington University School of Medicine, Saint Louis, MOAvi Z Rosenberg - Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MDHeather N Reich - University of TorontoPietro A Canetta - Columbia UniversityPatrick H Nachman - University of MinnesotaCarla Nester - University of Iowa Hospitals and Clinics, Iowa City, IARaed Bou-Matar - Case Western Reserve UniversityShikha Wadhwani - Northwestern UniversityLaura H Mariani - University of MichiganMyda Khalid - Indiana University School of MedicineCureGN IgA Working Group
- Resource Type
- Journal article
- Publication Details
- Clinical journal of the American Society of Nephrology, Vol.20(7), pp.978-992
- DOI
- 10.2215/CJN.0000000707
- PMID
- 40208688
- PMCID
- PMC12262914
- NLM abbreviation
- Clin J Am Soc Nephrol
- ISSN
- 1555-905X
- eISSN
- 1555-905X
- Publisher
- AMER SOC NEPHROLOGY
- Grant note
- National Institute of Diabetes and Digestive and Kidney Diseases
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Language
- English
- Electronic publication date
- 04/10/2025
- Date published
- 07/2025
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Internal Medicine
- Record Identifier
- 9984808527802771
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