Ying Wang, Shimin Jiang, Guming Zou, Li Zhuo, Wenge Li
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Main baseline information and the administration of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) were collected.</p><p><strong>Results: </strong>During a median follow-up time of 25.5 months, 21 (42.0%) patients reached ESRD and none died. Six patients had a baseline eGFR of 15-20 ml/min/1.73m<sup>2</sup>, and reached ESRD with a median renal survival time of 7.0 (range 6.0-23.0) months. Among patients with a baseline eGFR of 20-30 ml/min/1.73m<sup>2</sup>, the percentage of patients using ACEI/ARB in progressive group was much lower than that in stable group (33.3% vs. 62.1%, <i>P</i> = 0.045), together with a shorter renal survival time in progressive group (26.0 vs. 30.5 months, <i>P</i> = 0.033). Macroproteinuria (24 h - UP ≥ 2.5 g) was also associated with a shorter renal survival time, as well as a significant decline in eGFR of stable group (24.4 vs. 26.4 ml/min/1.73 m<sup>2</sup>, <i>P</i> = 0.026). Lower eGFR [hazards ratio (HR), 0.829, 95% confidence interval (CI), 0.724-0.950; <i>P</i> = 0.007] and use of ACEI/ARB (HR, 0.356, 95% CI, 0.133-0.953; <i>P</i> = 0.040) were predictive of time to ESRD in this stage. No differences were found in the expression of AT1R, AT2R, MasR, and MrgD of renal tissues at the time of biopsy between stable and progressive groups.</p><p><strong>Conclusion: </strong>Contingent on monitoring serum creatinine and potassium levels, IgAN with macroproteinuria and a GFR of 20-30 ml/min/1.73m<sup>2</sup> may still benefits from intrarenal RAS inhibition.</p>","PeriodicalId":17330,"journal":{"name":"Journal of the Renin-Angiotensin-Aldosterone System","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9822756/pdf/","citationCount":"0","resultStr":"{\"title\":\"IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m<sup>2</sup> May Still Benefit from RAS Inhibition.\",\"authors\":\"Ying Wang, Shimin Jiang, Guming Zou, Li Zhuo, Wenge Li\",\"doi\":\"10.1155/2022/9162427\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>There has been controversy about renin-angiotensin system (RAS) inhibition in IgAN patients with advanced (stage 4) chronic kidney disease (CKD). 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Among patients with a baseline eGFR of 20-30 ml/min/1.73m<sup>2</sup>, the percentage of patients using ACEI/ARB in progressive group was much lower than that in stable group (33.3% vs. 62.1%, <i>P</i> = 0.045), together with a shorter renal survival time in progressive group (26.0 vs. 30.5 months, <i>P</i> = 0.033). Macroproteinuria (24 h - UP ≥ 2.5 g) was also associated with a shorter renal survival time, as well as a significant decline in eGFR of stable group (24.4 vs. 26.4 ml/min/1.73 m<sup>2</sup>, <i>P</i> = 0.026). Lower eGFR [hazards ratio (HR), 0.829, 95% confidence interval (CI), 0.724-0.950; <i>P</i> = 0.007] and use of ACEI/ARB (HR, 0.356, 95% CI, 0.133-0.953; <i>P</i> = 0.040) were predictive of time to ESRD in this stage. 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引用次数: 0
摘要
关于IgAN对晚期(4期)慢性肾脏疾病(CKD)患者肾素-血管紧张素系统(RAS)的抑制一直存在争议。因此，我们研究了RAS阻断对这些患者的影响。方法:对2010年至2020年期间接受肾活检的50例4期CKD IgAN患者的肾脏标本进行免疫组织化学染色，检测RAS受体(AT1R、AT2R、MasR和MrgD)的表达。主要终点是终末期肾病(ESRD)和死亡的综合指标。收集主要基线信息和血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻滞剂(ARB)的使用情况。结果:在25.5个月的中位随访期间，21例(42.0%)患者达到ESRD，无患者死亡。6例患者基线eGFR为15-20 ml/min/1.73m2，达到ESRD，中位肾生存时间为7.0(6.0-23.0)个月。在基线eGFR为20 ~ 30 ml/min/1.73m2的患者中，进展组使用ACEI/ARB的患者比例远低于稳定组(33.3% vs. 62.1%， P = 0.045)，且进展组肾生存时间较短(26.0 vs. 30.5个月，P = 0.033)。大蛋白尿(24 h - UP≥2.5 g)也与肾脏生存时间缩短相关，稳定组eGFR显著下降(24.4 vs. 26.4 ml/min/1.73 m2, P = 0.026)。较低的eGFR[危险比(HR)， 0.829, 95%可信区间(CI)， 0.724-0.950;P = 0.007]和ACEI/ARB的使用(HR, 0.356, 95% CI, 0.133-0.953;P = 0.040)预测该阶段发生ESRD的时间。稳定组和进展组肾组织活检时AT1R、AT2R、MasR和MrgD的表达均无差异。结论:在监测血清肌酐和钾水平的情况下，伴有大蛋白尿和GFR为20-30 ml/min/1.73m2的IgAN仍可能受益于肾内RAS抑制。
IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m2 May Still Benefit from RAS Inhibition.
Introduction: There has been controversy about renin-angiotensin system (RAS) inhibition in IgAN patients with advanced (stage 4) chronic kidney disease (CKD). Therefore, we investigated the effect of RAS blockade in these patients.
Methods: Renal specimens of 50 IgAN patients who underwent renal biopsy during stage 4 CKD between 2010 and 2020, were stained using immunohistochemistry to detect the expression of RAS receptors (AT1R, AT2R, MasR, and MrgD). The primary endpoint was a composite of end-stage renal disease (ESRD) and death. Main baseline information and the administration of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) were collected.
Results: During a median follow-up time of 25.5 months, 21 (42.0%) patients reached ESRD and none died. Six patients had a baseline eGFR of 15-20 ml/min/1.73m2, and reached ESRD with a median renal survival time of 7.0 (range 6.0-23.0) months. Among patients with a baseline eGFR of 20-30 ml/min/1.73m2, the percentage of patients using ACEI/ARB in progressive group was much lower than that in stable group (33.3% vs. 62.1%, P = 0.045), together with a shorter renal survival time in progressive group (26.0 vs. 30.5 months, P = 0.033). Macroproteinuria (24 h - UP ≥ 2.5 g) was also associated with a shorter renal survival time, as well as a significant decline in eGFR of stable group (24.4 vs. 26.4 ml/min/1.73 m2, P = 0.026). Lower eGFR [hazards ratio (HR), 0.829, 95% confidence interval (CI), 0.724-0.950; P = 0.007] and use of ACEI/ARB (HR, 0.356, 95% CI, 0.133-0.953; P = 0.040) were predictive of time to ESRD in this stage. No differences were found in the expression of AT1R, AT2R, MasR, and MrgD of renal tissues at the time of biopsy between stable and progressive groups.
Conclusion: Contingent on monitoring serum creatinine and potassium levels, IgAN with macroproteinuria and a GFR of 20-30 ml/min/1.73m2 may still benefits from intrarenal RAS inhibition.
期刊介绍：
JRAAS is a peer-reviewed, open access journal, serving as a resource for biomedical professionals, primarily with an active interest in the renin-angiotensin-aldosterone system in humans and other mammals. It publishes original research and reviews on the normal and abnormal function of this system and its pharmacology and therapeutics, mostly in a cardiovascular context but including research in all areas where this system is present, including the brain, lungs and gastro-intestinal tract.
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