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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Medicine+(Baltimore)
2017 ; 96
(44
): e8154
Nephropedia Template TP
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Determination of the optimal target level of proteinuria in the management of
patients with glomerular diseases by using different definitions of proteinuria
#MMPMID29095250
Kee YK
; Yoon CY
; Kim SJ
; Moon SJ
; Kim CH
; Park JT
; Lim BJ
; Chang TI
; Kang EW
; Kie JH
; Yoo TH
; Jeong HJ
; Kang SW
; Han SH
Medicine (Baltimore)
2017[Nov]; 96
(44
): e8154
PMID29095250
show ga
Proteinuria is a major determinant of adverse renal outcome, and its reduction
slows renal progression in glomerular diseases. However, the optimal target of
proteinuria in glomerular diseases is unclear, and discrepancies in the
definition of proteinuria produce ambiguous findings. Here we investigated the
optimal target of proteinuria by using different definitions of proteinuria. We
analyzed 574 IgA nephropathy (IgAN), 175 membranous nephropathy (MGN), and 177
focal segmental glomerulosclerosis (FSGS) cases from 3 Korean kidney centers. We
evaluated the impact of proteinuria on renal outcome with 2 definitions:
time-average proteinuria (TAP) and time-varying proteinuria (TVP). The endpoint
was renal progression, defined as a 50% decline in glomerular filtration rate or
end-stage renal disease. During a median follow-up of 57.3 months, the primary
outcome occurred in 54 patients with IgAN, 26 with MGN, and 30 with FSGS.
Multivariate Cox regression using TAP indicated that there was a linear
association between proteinuria and risk of renal progression in IgAN. However,
moderate proteinuria was not associated with an increased risk of renal
progression in MGN and FSGS. In contrast, the analysis by TVP showed that the
risk significantly increased in proportion to proteinuria during follow-up in all
3 diseases. Our findings suggest that TVP-based model can delineate association
between proteinuria and risk of renal progression better than TAP-based model,
considering that TVP reflects the dynamic change of proteinuria over time. Thus,
proteinuria reduction to the lowest possible level is required to improve renal
outcomes in patients with glomerular diseases.