The role of urine IgG in the progression of IgA nephropathy with a high proportion of global glomerulosclerosis

Abstract

Background: IgA nephropathy (IgAN), the most common glomerulonephritis in the world, is an important cause of end-stage renal disease (ESRD). It is necessary to explore new prognostic markers for predicting the activity and progress of IgAN. There are few studies on new prognostic markers in IgAN patients with high proportion of glomerulosclerosis. This study aims to explore the value of urine IgG in predicting the prognosis of IgAN patients.

Methods: The primary end point of this retrospective study was a composite event with a reduction in estimated glomerular filtration rate (eGFR) of ≥ 50% or ESRD or death. This study assessed the association between urinary IgG and clinicopathological parameters, as well as the prognosis of a high proportion of patients with global glomerulosclerotic IgAN.

Results: This study included 105 IgAN patients with high proportion of global glomerulosclerotic. The level of urinary protein IgG was significantly correlated with clinical prognostic factors. The level of urinary protein IgG was positively correlated with urinary protein excretion (rs = 0.834, P < 0.001), CRP (rs = 0.375, P < 0.001), and C4 (rs = 0.228, P = 0.019), and negatively correlated with eGFR (rs = - 0.307, P = 0.001). In addition, the level of urinary IgG increased with the increase of tubulointerstitial injury rate, which was positively correlated with endothelial cell proliferation and crescent (all P < 0.05). Prognostic analysis using the Cox proportional hazard regression model and Kaplan-Meier survival curve further determined that urine IgG is an independent risk factor for the prognosis of IgAN with high proportion of global glomerulosclerosis.

Conclusions: This study determined that urine IgG can be used as a useful predictor of the prognosis of IgAN patients with high proportion global glomerulosclerosis. The mechanism of urine IgG trends in IgAN with high proportion of glomerulosclerosis needs further study.

Keywords: IgA nephropathy; Prognosis; Prognostic marker; Urine IgG.