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The best predictor of IgA nephropathy progression: ACR

  Proteinuria is an independent predictor of IgAN nephropathy (IgAN) progression. Urine albumin creatinine ratio (ACR), urinary protein creatinine ratio and 24-hour urinary protein excretion (UPE) are widely used in clinical practice of proteinuria assessment. A recent study published in the journal Clin J Am Soc Nephrol explored the association of ACR, urinary protein creatinine ratio, and UPE with IgAN clinical and pathologic findings, as well as best predictors of IgAN prognosis.

  Urine samples from 438 patients diagnosed with IgAN between 2003 and 2012 were analyzed and studied for ≥12 months. Urinary ACR, urinary protein creatinine ratio and 24-hour UPE were measured in a renal biopsy using a Hitachi Automatic Biochemical Analyzer 7180 (Japan).

  The results showed that ACR, urinary protein creatinine ratio, and 24-hour UPE were highly correlated with IgAN clinical and pathological findings (correlation coefficient: 0.71-0.87). All three markers were well correlated with markers of response severity of IgA nephropathy, such as eGFR, hypertension, and biopsy parameters (Oxford classification of tubular atrophy / interstitial fibrosis). However, only ACR correlated positively with Oxford's classification of glomerulosclerosis and extra-capillary proliferative lesions. A total of 124 patients achieved a composite end point (eGFR decreased by 30%, ESRD or death). Single factor survival analysis showed that ACR performance was consistently superior to urinary protein creatinine ratio and 24-hour UPE; time-dependent survival analysis, the larger the area under the curve. After adjustment for known risk factors for IgAN progression, ACR had the greatest correlation with composite end points (hazard ratio 1.56 / ACR square root normalized, 1-SD per 95% confidence interval, 1.29-1.89 after normalization); P <0.001 ). The ability of ACR to predict the progression of IgAN was further improved when compared to the 24-hour UPE and the addition of conventional risk factors (C statistic: ACR = 0.70; urinary protein-creatinine ratio = 0.68; 24-hour UPE = 0.69; (Akirake information criterion): ACR = 1217.85; urinary protein-creatinine ratio = 1229.28; 24-hour UPE = 1234.96; P <0.001).

  CONCLUSIONS: ACR, urinary protein-creatinine ratio, and 24-hour UPE were associated with significant clinical and pathological findings in IgA nephropathy, the researchers conclude. ACR predicts better progression of IgA nephropathy compared with urinary protein-creatinine ratio and 24-hour UPE.

  Source: Measures of Urinary Protein and Albumin in the Prediction of Progression of IgA Nephropathy. Clin J Am Soc Nephrol. 2016 Jun 6; 11 (6): 947-55.

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