Association of Relapse with Renal Outcomes under the Current Therapy Regimen for IgA Nephropathy: A Multi-Center Study

Yuan, Yanhong; Che, Xiajing; Ni, Zhaohui; Zhong, Yifei; Qi, Yinghui; Shao, Xinghua; Wang, Qin; Cao, Liou; Zhang, Minfang; Xie, Yuanyuan; Chen, Qi; Tian, Lei; Mou, Shan

doi:10.1371/journal.pone.0137870

Cited by 8 publications

(4 citation statements)

References 34 publications

(51 reference statements)

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“…On the other hand, the relapse rates in our trial, i.e. 16.1% in the CS group and 14.8% in the LEF group, were also similar between groups and comparable to those reported by Yuan et al [ 28 ].…”

Section: Discussionsupporting

confidence: 91%

Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy

et al. 2017

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IgA nephropathy is the most common primary glomerulonephritis and one of the leading causes of end-stage renal disease. We performed a randomized, controlled, prospective, open-label trial to determine whether leflunomide combined with low-dose corticosteroid is safe and effective for the treatment of progressive IgA nephropathy, as compared to full-dose corticosteroid monotherapy. Biopsy-proved primary IgA nephropathy patients with an estimated glomerular filtration rate ≥ 30 ml/min/1.73m2 and proteinuria ≥1.0 g/24h were randomly assigned to receive leflunomide+low-dose corticosteroid (leflunomide group; n = 40) or full-dose corticosteroid (corticosteroids group; n = 45). The primary outcome was renal survival; secondary outcomes were proteinuria and adverse events. After 12 months of treatment and an average follow-up of 88 months, 11.1% vs. 7.5% of patients reached end-stage renal disease and 20% versus 10% of patients had a ≥ 50% increase in serum creatinine in the corticosteroids and leflunomide groups, respectively. Kaplan-Meier analysis did not reveal a between-group difference in these outcomes. Decreases in 24-hour proteinuria were similar in the two groups during the treatment period, but a more marked reduction was observed during follow-up in the leflunomide group. Although the incidence of adverse events was similar in the two groups, serious adverse events were observed only in the corticosteroid group. Thus, leflunomide combined with low-dose corticosteroid is at least as effective as corticosteroid alone for the treatment of progressive IgA nephropathy, and showed a greater reduction of proteinuria during long-term follow-up and fewer severe adverse events.

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Section: Discussionsupporting

confidence: 91%

Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy

et al. 2017

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“…In recent years, several nomogram models have been constructed to predict the recurrence of the disease early [ 36 , 37 ]. At present, there is no nomogram model for predicting the relapse probability of PMN.…”

Section: Discussionmentioning

confidence: 99%

A preliminary nomogram model for predicting relapse of patients with primary membranous nephropathy

Wang

Lai

et al. 2023

Renal Failure

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Objective To explore the predictive factors and establish a nomogram model for predicting relapse risk in primary membranous nephropathy (PMN). Methods The clinical, laboratory, pathological and follow-up data of patients with biopsy-proven membranous nephropathy were collected in the Affiliated Hospital of Qingdao University. A total of 400 PMN patients who achieved remission were assigned to the development group ( n = 280) and validation group ( n = 120) randomly. Cox regression analysis was performed in the development cohort to determine the predictive factors of relapse in PMN patients, a nomogram model was established based on the multivariate Cox regression analysis and validated in the validation group. C-index and calibration plots were used to evaluate the discrimination and calibration performance of the model respectively. Result Hyperuricemia (HR = 2.938, 95% CI 1.875–4.605, p < 0.001), high C-reactive protein (CRP) (HR = 1.147, 95% CI 1.086–1.211, p < 0.001), and treatment with calcineurin inhibitors with or without glucocorticoids (HR = 2.845, 95%CI 1.361–5.946, p = 0.005) were independent risk factors, while complete remission (HR = 0.420, 95%CI 0.270–0.655, p < 0.001) was a protective factor for relapse of PMN according to multivariate Cox regression analysis, then a nomogram model for predicting relapse of PMN was established combining the above indicators. The C-indices of this model were 0.777 (95%CI 0.729–0.825) and 0.778 (95%CI 0.704–0.853) in the development group and validation group respectively. The calibration plots showed that the predicted relapse probabilities of the model were consistent with the actual probabilities at 1, 2 and 3 years, which indicated favorable performance of this model in predicting the relapse probability of PMN. Conclusions Hyperuricemia, remission status, CRP and therapeutic regimen were predictive factors for relapse of PMN. A novel nomogram model with good discrimination and calibration was constructed to predict relapse risk in patients with PMN early.

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“…Until now, no ideal risk prediction model has been sufficiently validated for predicting the progression of IgAN. Yuan et al 15 developed a nomogram with the data of 489 patients for predicting the relapse of IgAN. Only two clinical parameters, gender and DBP, were included, and the C-index was 0.78.…”

Section: Discussionmentioning

confidence: 99%

Development and assessment of a predictive nomogram for the progression of IgA nephropathy

Liu

Zhu

Zheng

et al. 2018

Sci Rep

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The present study is to establish a nomogram for predicting the prognosis of IgA nephropathy (IgAN). Of the 869 IgAN patients, four-fifths were randomly assigned to the development cohort and one-fifth to the validation cohort. The primary outcome was a composite event of either a ≥ 50% reduction in estimated glomerular filtration rate (eGFR), end-stage renal disease or death. The mean follow-up time was 44 months. The Cox regression model identified urinary protein excretion (1–3.5 g/d, HR 11.639, 95% CI 3.601–37.625; ≥ 3.5 g/d, HR 32.435, 95% CI 10.079–104.380), eGFR (G2, HR 5.293, 95% CI 2.011–13.932; G3, HR 15.797, 95% CI 6.584–37.905; G4, HR 34.619, 95% CI 13.887–86.301; G5, HR 217.651, 95% CI 83.807–565.248), hyperuricaemia (HR 7.031, 95% CI 4.126–11.980), mesangial proliferation (HR 36.667, 95% CI 5.098–263.711), segmental glomerulosclerosis (HR 5.122, 95% CI 3.114–8.425), tubular atrophy/interstitial fibrosis (T1, HR 33.351, 95% CI 7.831–142.044; T2, HR 213.888, 95% CI 51.048–896.182), crescents (C1, HR 3.123, 95% CI 1.771–5.510; C2, HR 7.353, 95% CI 3.590–15.062) and glomerulosclerosis (25–49%, HR 3.123, 95% CI 1.771–5.510; ≥ 50%, HR 14.384, 95% CI 8.813–23.479) for developing the nomogram. The C-index was 0.945 (95% CI 0.914–0.976) in both the development and validation cohorts, showing good agreement between the nomogram-predicted probability and actual free-of-progression probability. Thus, our nomogram could accurately predict the progression of IgAN patients.

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Association of Relapse with Renal Outcomes under the Current Therapy Regimen for IgA Nephropathy: A Multi-Center Study

Cited by 8 publications

References 34 publications

Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy

Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy

A preliminary nomogram model for predicting relapse of patients with primary membranous nephropathy

Development and assessment of a predictive nomogram for the progression of IgA nephropathy

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