Selective Proteinuria Index as a Prognostic Index in IgA Nephropathy.
- Author:
Young Suck GOO
1
;
Ea Wha KANG
;
Sang Cheol LEE
;
Seung Hyeok HAN
;
Hee Doo KYUNG
;
Jae Hun JUNG
;
Soo Young YOON
;
So Rae CHOI
;
Hyun Jung ROH
;
Hyeong Cheon PARK
;
Shin Wook KANG
;
Kyu Hun CHOI
;
Dae Suk HAN
;
Ho Yung LEE
Author Information
1. Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea. gooys@freechal.com
- Publication Type:Original Article
- Keywords:
Selective proteinuria index;
IgA nephropathy
- MeSH:
Predictive Value of Tests
- From:Korean Journal of Nephrology
2001;20(5):890-897
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Proteinuria is the hallmark of glomerular injury and results from alterations in glomerular permeability. The permeability of diseased glomerulus has been estimated by selectivity of proteinuria. Recently, some authors showed a significant relationship between selectivity of proteinuria and tubulointerstial damage. The present study examines the role of protein selectivity as a prognostic marker in patients with IgA nephropathy and its correlation with other prognostic indices. METHODS: The selective proteiuria index of 81 cases with IgA nephropathy diagnosed between 1990 and 2000 were reviewed, and each case was subclassified using the following : highly selective(SPI0.2). The mean age of the patients was 27+/-15 years with a follow-up period of 38+/-24 months. Six patients had highly selective proteinuria, thirty three patients had moderately selective proteinuria, and forty two patients had nonselective proteinuria. RESULTS: 1) A significant relationship was found between the SPI and Haas subclasess(p=0.01). With respect to clinical presentaion, hypertension(0, 4, 11 cases, p<0.05), proteinuria(0.52+/-0.35, 1.85+/-1.55, 2.79+/-2.51 g/day, p<0.05) were significant correlation.2) Chronic renal failure was significantly higher in patients with nonselective proteinuria in comparison with patients with selective proteinuria(p<0.05).3) Markers of renal failure by the Cox proportional hazards model were Cr(Exp(B)=4.2, p<0.001), Ccr (Exp(B)=2.1, p<0.05), SPI(Exp(B)=1.7, p<0.05), hypertension(Exp(B)=1.6, p<0.05). 4) In 28 patients of IgA nephropathy with nephrotic syndrome, 9 patients were moderately selective, 19 patients were nonselective. The response to therapy, evaluated retrospectively, was 67% and 16% in moderate and nonselective proteinuria(p=0.01). CONCLUSION: There is a significant relationship between selectivity of proteinuria and clinical para meters. Moreover, the selectivity of proteinuria has a predictive value on functional outcome.
