PROGNOSTIC PREDICTION OF LONG-TERM CLINICAL COURSES IN INDIVIDUAL IGANEPHROPATHY PATIENTS

This study was performed to evaluate predictive factors determining a long-term prognosis in individual IgA nephropathy patients. One hundre d and fifty-five patients who have been continuously followed up for 1 0 years or more from the first renal biopsy in our renal unit were the subjects of this study. As predictive factors, initial proteinuria, i nitial creatinine clearance (Ccr) values, initial hypertension, histol ogical severity (eight parameters and total score), persistence of mas sive proteinuria (% duration of massive proteinuria; % DP) and persist ence of hypertension were evaluated. All 25 of the 155 patients who ha d either high total score of 17 or more, or less than 60 mL/min in ini tial Ccr values, went onto haemodialysis (HD). However, all 38 patient s who had TS of 4 or less did not. The remaining 95 patients who showe d both total score from 5 to 16 and Ccr values of 60 mL/min or more we re divided into two groups: HD group (32 cases) and non-HD group (63 c ases). All patients but one in the HD group showed 30% or more in %DP, and 50 of 63 patients in the non-HD group showed 30% or less (P<0.001 ). Multivariate analysis using a logistic model of factors associated with prognosis indicating HD revealed that %DP was the highest relativ e risk (19.5) compared with interstitial fibrosis (10.2), initial Ccr values (6.8), persistent hypertension (4.2) and initial proteinuria (1 .4). These results indicated that the most reliable, independent facto r determining a long-term individual prognosis is persistent massive p roteinuria of 1.0 g/day or more.