Long-term renal outcomes of IgA nephropathy presenting with different levels of proteinuria
CLINICAL NEPHROLOGY
Authors: Ai, Zhen; Zhou, Qian; Huang, Fengxian; Yang, Qiongqiong; Yu, Xueqing
Abstract
Aims: Proteinuria is a strong prognostic factor in IgA nephropathy (IgAN). However, the risk threshold of proteinuria for kidney disease progression remains in debate. This study aimed to evaluate the risk of different levels of proteinuria on renal outcomes in Chinese patients with IgAN. Materials and methods: Patients with biopsy-proven primary IgAN were recruited and divided into four groups based on their proteinuria levels: <= 0.30 g/d, 0.31 - 0.50 g/d, 0.51 - 1.00 g/d, and > 1.00 g/d. The primary outcomes were composed by doubling of baseline senor creatinine (Scr) and end-stage renal disease (ESRD, defined as eGFR < 15 mL/min/1.73m2, initiation of dialysis or transplantation). Results: A total of 921 IgAN patients were enrolled in this study. During a median follow-up duration of 48 (34 - 62) months, higher risks of doubling of baseline Scr developed in patients with proteinuria 0.31 - 0.50 g/d (HR = 2.87, p = 0.04), 0.51 - 1.00 g/d (HR = 4.26, p = 0.002), and > 1.00 g/d (HR = 14.56, p < 0.001), while increased risks for ESRD were observed in patients with proteinuria 0.51 - 1.00 g/d (HR = 3.00, p = 0.02) and > 1.00 g/d (HR = 13.03, p < 0.001) in unadjusted Cox regression models. After adjusted for potential confounders, proteinuria 0.31 - 0.50 g/d (HR = 3.70, p = 0.04), 0.51 - 1.00 g/d (HR = 3.67, p = 0.02), and > 1.00 g/d (HR = 8.20, p < 0.001) remained to be significantly associated with higher risks of doubling of Scr, while only those with proteinuria > 1.00 g/d (HR = 6.04, p = 0.001) exhibited a markedly increased risk of ESRD. Conclusion: Patients with proteinuria levels > 0.30 g/d already have a higher risk of doubling of baseline Scr, suggesting the necessity of early intervention in patients presenting with minimal proteinuria.
Early clinical factors predicting the development of critical disease in Japanese patients with COVID-19: A single-center, retrospective, observational study
JOURNAL OF MEDICAL VIROLOGY
Authors: Higuchi, Takatoshi; Nishida, Tsutomu; Iwahashi, Hiromi; Morimura, Osamu; Otani, Yasushi; Okauchi, Yukiyoshi; Yokoe, Masaru; Suzuki, Norihiro; Inada, Masami; Abe, Kinya
Abstract
The factors predicting the progression of coronavirus disease-2019 (COVID-19) from mild to moderate to critical are unclear. We retrospectively evaluated risk factors for disease progression in Japanese patients with COVID-19. Seventy-four patients with laboratory-confirmed COVID-19 were hospitalized in our hospital between February 20, 2020, and June 10, 2020. We excluded asymptomatic, non-Japanese, and pediatric patients. We divided patients into the stable group and the progression group (PG; requiring mechanical ventilation). We compared the clinical factors. We established the cutoff values (COVs) for significantly different factors via receiver operating characteristic curve analysis and identified risk factors by univariate regression. We enrolled 57 patients with COVID-19 (median age 52 years, 56.1% male). The median time from symptom onset to admission was 8 days. Seven patients developed critical disease (PG: 12.2%), two (3.5%) of whom died; 50 had stable disease. Univariate logistic analysis identified an elevated lactate dehydrogenase (LDH) level (COV: 309 U/l), a decreased estimated glomerular filtration rate (eGFR; COV: 68 ml/min), lymphocytopenia (COV: 980/mu l), and statin use as significantly associated with disease progression. However, in the Cox proportional hazards analysis, lymphocytopenia at admission was not significant. We identified three candidate risk factors for progression to critical COVID-19 in adult Japanese patients: statin use, elevated LDH level, and decreased eGFR.
COA
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