TY - JOUR
T1 - Proteinuria Trajectory and Disease Progression in Children and Adults with IgA Nephropathy/Vasculitis
AU - CureGN IgA Working Group
AU - Glenn, Dorey A.
AU - Carver, Ashley W.
AU - Helmuth, Margaret E.
AU - Smith, Abigail R.
AU - Lafayette, Richard A.
AU - Ravipati, Prasanth
AU - Oliverio, Andrea L.
AU - Rizk, Dana V.
AU - Novak, Jan
AU - Lugani, Francesca
AU - Bartosh, Sharon M.
AU - Mucha, Krzysztof
AU - Kiryluk, Krzysztof
AU - Saha, Manish K.
AU - Nast, Cynthia C.
AU - Hou, Jean
AU - Biederman, Laura E.
AU - Messias, Nidia
AU - Rosenberg, Avi Z.
AU - Reich, Heather N.
AU - Canetta, Pietro A.
AU - Nachman, Patrick H.
AU - Nester, Carla
AU - Bou-Matar, Raed
AU - Wadhwani, Shikha
AU - Mariani, Laura H.
AU - Khalid, Myda
N1 - Publisher Copyright:
Copyright © 2025 by the American Society of Nephrology.
PY - 2025/7/1
Y1 - 2025/7/1
N2 - Background Identifying patients with IgA nephropathy at risk of disease progression is critical for clinical decision making, risk-based patient counseling, and optimal enrollment of clinical trials. Methods Patients with IgA nephropathy and IgA vasculitis with nephritis were enrolled in the Cure Glomerulonephropathy Network, a multicenter 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 2 years. Linear mixed models were used to calculate predicted eGFR slope. In adults, Cox proportional hazard models were used to model time to kidney failure or 40% eGFR decline as a function of the proteinuria trajectory group. Results Of 919 patients with IgA nephropathy/IgA vasculitis with nephritis enrolled into the Cure Glomerulonephropathy Network, 368 adults and 234 children were included in the analysis. In the full adult cohort, group 1 had the lowest levels of proteinuria (interquartile range [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. The average predicted time to eGFR,15 ml/min per 1.73 m2 was .90, 16, and 8 years and .90, 67, and 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% confidence interval [CI], 1.84 to 5.33), 1.98 (95% CI, 0.97 to 4.06), and 3.36 (95% CI, 1.59 to 7.13) times higher hazard of progressing to a composite outcome compared with group 2 membership in the full, prevalent, and histology cohorts, respectively, but not associated with progression in the incident cohort. Conclusions Proteinuria trajectory is a major predictor of disease progression in patients with IgA nephropathy.
AB - Background Identifying patients with IgA nephropathy at risk of disease progression is critical for clinical decision making, risk-based patient counseling, and optimal enrollment of clinical trials. Methods Patients with IgA nephropathy and IgA vasculitis with nephritis were enrolled in the Cure Glomerulonephropathy Network, a multicenter 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 2 years. Linear mixed models were used to calculate predicted eGFR slope. In adults, Cox proportional hazard models were used to model time to kidney failure or 40% eGFR decline as a function of the proteinuria trajectory group. Results Of 919 patients with IgA nephropathy/IgA vasculitis with nephritis enrolled into the Cure Glomerulonephropathy Network, 368 adults and 234 children were included in the analysis. In the full adult cohort, group 1 had the lowest levels of proteinuria (interquartile range [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. The average predicted time to eGFR,15 ml/min per 1.73 m2 was .90, 16, and 8 years and .90, 67, and 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% confidence interval [CI], 1.84 to 5.33), 1.98 (95% CI, 0.97 to 4.06), and 3.36 (95% CI, 1.59 to 7.13) times higher hazard of progressing to a composite outcome compared with group 2 membership in the full, prevalent, and histology cohorts, respectively, but not associated with progression in the incident cohort. Conclusions Proteinuria trajectory is a major predictor of disease progression in patients with IgA nephropathy.
KW - CKD
KW - Henoch-Schonlein purpura (IgA vasculitis)
KW - IgA nephropathy
KW - clinical epidemiology
KW - glomerular disease
KW - pediatric nephrology
KW - pediatrics
UR - https://www.scopus.com/pages/publications/105003044415
UR - https://www.scopus.com/pages/publications/105003044415#tab=citedBy
U2 - 10.2215/CJN.0000000707
DO - 10.2215/CJN.0000000707
M3 - Article
C2 - 40208688
AN - SCOPUS:105003044415
SN - 1555-9041
VL - 20
SP - 978
EP - 992
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 7
ER -