Early prediction of IgA nephropathy progression: Proteinuria and AOPP are strong prognostic markers.Background. Inflammation and oxidative stress have been incriminated in the pathogenesis of IgA nephropathy (IgAN). The aim of the present study was to assess whether markers reflecting these pathophysiologic processes, namely C-reactive protein (CRP) and advanced oxidation protein products (AOPP), would allow-in conjunction with clinical and histopathologic parameters-to predict disease progression.Methods. Between 1994 and 1997, 120 adult patients with biopsy-proven IgAN were included in a prospective cohort study, and followed until the end of 2002 or start of dialysis. In every patient, we determined plasma levels of CRP and AOPP. These parameters were included, together with clinical data, in a multivariate Cox proportional hazard regression analysis, with halving of baseline creatinine clearance as the primary renal end point.Results. A total of 51 patients reached the renal end point, including 30 who had to start dialysis. With multivariate analysis, the most potent independent risk factors of poor renal outcome were proteinuria ≥1 g/day [proportional hazard risk (HR) = 23.7, P = 0.0001], hypertension (HR = 8.13, P = 0.008), and AOPP plasma level (HR = 1.09 per 10 lmol/L, P = 0.042), whereas angiotensin II inhibitors were protective (HR = 0.19, P = 0.001).Conclusion. Our data support the role of oxidative stress in the pathogenesis of IgAN and suggest that patients with proteinuria ≥1 g/day should be eligible for early implemented antioxidant and/or anti-inflammatory therapeutic strategies, with AOPP plasma level as a surrogate marker to evaluate their effects.Immunoglobulin A nephropathy (IgAN), or Berger's disease, is the most common type of primary glomeru-
There are doubts about whether the values obtained from the Cockroft-Gault (ClCG) and Modification of Diet in Renal Disease (GFRMDRD) formulas are comparable to the more traditional formula used to obtain the creatinine clearance from a 24-hour urine collection (ClCrm), particularly in patients with only one kidney. The present study aimed to compare these formulas in individuals with one remaining kidney after previous nephrectomy (Nx) and to verify which estimated formula correlates more closely with ClCrm. Thirty-six patients who had undergone Nx had their renal filtration analyzed with ClCG, GFRMDRD and by ClCrm. The average time after Nx was 11.6 ± 9.0 years, and the average age at the time of the study was 50.7 ± 10.6 years old (X ± SD). The results of three clearances were 81.1 ± 35.6 mL·min·m2 for ClCrm, 70.4 ± 24.0 mL·min·m2 for ClCrCG, and 71.2 ± 19.2 mL·min·m2 for GFRMDRD (with ClCrm > ClCrCG and GFRMDRD; P < .001). No difference was found between the ClCrCG and GFRMDRD values (P = .72). The data demonstrated that both estimate formulas were strongly correlated with ClCrm, although ClCrCG was more closely associated with ClCrm than GFRMDRD (ClCrCG with r2 : 0.64 and GFRMDRD with r2 : 0.34; P < .001). In conclusion, for people with only one kidney remaining after NX, our data showed that glomerular filtration rate estimation by ClCrCG is more related to the values obtained with the traditional clearance measurement based on a 24-hour urine collection test.
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