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• W4313365417 abstract "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%, <math xmlns=http://www.w3.org/1998/Math/MathML id=M1> <mi>P</mi> <mo>=</mo> <mn>0.045</mn> </math> ), together with a shorter renal survival time in progressive group (26.0 vs. 30.5 months, <math xmlns=http://www.w3.org/1998/Math/MathML id=M2> <mi>P</mi> <mo>=</mo> <mn>0.033</mn> </math> ). Macroproteinuria ( <math xmlns=http://www.w3.org/1998/Math/MathML id=M3> <mn>24</mn> <mtext> </mtext> <mtext>h</mtext> <mo>−</mo> <mtext>UP</mtext> <mo>≥</mo> <mn>2.5</mn> <mtext> </mtext> <mtext>g</mtext> </math> ) 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, <math xmlns=http://www.w3.org/1998/Math/MathML id=M4> <mi>P</mi> <mo>=</mo> <mn>0.026</mn> </math> ). Lower eGFR [hazards ratio (HR), 0.829, 95% confidence interval (CI), 0.724-0.950; <math xmlns=http://www.w3.org/1998/Math/MathML id=M5> <mi>P</mi> <mo>=</mo> <mn>0.007</mn> </math> ] and use of ACEI/ARB (HR, 0.356, 95% CI, 0.133-0.953; <math xmlns=http://www.w3.org/1998/Math/MathML id=M6> <mi>P</mi> <mo>=</mo> <mn>0.040</mn> </math> ) 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." @default.
• W4313365417 created "2023-01-06" @default.
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• W4313365417 date "2022-12-30" @default.
• W4313365417 modified "2023-09-26" @default.
• W4313365417 title "IgA Nephropathy with Macroproteinuria and a GFR of 20-30 ml/min/1.73 m2 May Still Benefit from RAS Inhibition" @default.
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• W4313365417 doi "https://doi.org/10.1155/2022/9162427" @default.
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