Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy
Sevillano, Ángel M. (Hospital 12 de Octubre (Madrid))
Caravaca-Fontán, Fernando (Hospital 12 de Octubre (Madrid))
Cordero Garcia-Galan, Lucía (Hospital 12 de Octubre (Madrid))
Fernández-Juarez, Gema (Hospital Universitario Fundación Alcorcón)
López-Revuelta, Katia (Hospital Universitario Fundación Alcorcón)
Guzmán, Diomaris A. (Hospital Regional Universitario de Málaga)
Martín-Reyes, Guillermo (Hospital Regional Universitario de Málaga)
Quintana, Luis F. (Hospital Clínic i Provincial de Barcelona)
Rodas, Lidia M. (Hospital Clínic i Provincial de Barcelona)
Sanchez de la Nieta, María Dolores (Hospital General Universitario de Ciudad Real)
Rabasco, Cristina (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Espinosa, Mario (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Díaz Encarnación, Montserrat (Fundació Puigvert)
San Miguel, Luz (Fundació Puigvert)
Barrios, Clara (Hospital del Mar (Barcelona, Catalunya))
Rodriguez, Eva (Hospital del Mar (Barcelona, Catalunya))
Garcia, Patricia (Hospital Virgen de la Victoria (Màlaga, Andalusia))
Valera, Alfonso (Hospital Virgen de la Victoria (Màlaga, Andalusia))
Peña, Jessy Korina (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
Shabaka, Amir (Hospital Universitario Fundación Alcorcón)
Velo, Mercedes (Hospital Clínico San Carlos (Madrid))
Sierra, Milagros (Hospital San Pedro (Logroño, La Rioja))
Gonzalez, Fayna (Hospital Universitario Dr. Negrin (Gran Canarias))
Fernandez-Reyes, María José (Hospital General de Segovia (Castella i Lleó))
Heras, Manuel (Hospital General de Segovia (Castella i Lleó))
Delgado, Patricia (Hospital Universitario de Canarias (La Laguna))
Gutierrez, Eduardo (Hospital 12 de Octubre (Madrid))
Moreno Gutiérrez, Juan Antonio (Maimonides Biomedical Research Institute of Cordoba (IMIBIC)(Còrdova, Andalusia))
Praga, Manuel (Instituto de Investigación Hospital 12 de Octubre (imas12) (Madrid))
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Macroscopic hematuria (MH) bouts, frequently accompanied by acute kidney injury (AKI-MH) are one of the most common presentations of IgA nephropathy (IgAN) in the elderly. Immunosuppressive therapies are used in clinical practice; however, no studies have analyzed their efficacy on kidney outcomes. This is a retrospective, multicenter study of a cohort of patients aged ≥50 years with biopsy-proven IgAN presenting with AKI-MH. Outcomes were complete, partial, or no recovery of kidney function at 1 year after AKI-MH, and kidney survival at 1, 2, and 5 years. Propensity score matching (PSM) analysis was applied to balance baseline differences between patients treated with immunosuppression and those not treated with immunosuppression. The study group consisted of 91 patients with a mean age of 65 ± 15 years, with a mean follow-up of 59 ± 36 months. Intratubular red blood cell (RBC) casts and acute tubular necrosis were found in all kidney biopsies. The frequency of endocapillary hypercellularity and crescents were low. Immunosuppressive therapies (corticosteroids alone or combined with mycophenolate mofetil or cyclophosphamide) were prescribed in 52 (57%) patients, whereas 39 (43%) received conservative treatment. There were no significant differences in the proportion of patients with complete, partial, or no recovery of kidney function at 1 year between patients treated with immunosuppression and those not treated with immunosuppression (29% vs. 36%, 30. 8% vs. 20. 5% and 40. 4 % vs. 43. 6%, respectively). Kidney survival at 1, 3, and 5 years was similar among treated and untreated patients (85% vs. 81%, 77% vs. 76% and 72% vs. 66%, respectively). Despite the PSM analysis, no significant differences were observed in kidney survival between the two groups. Fourteen patients (27%) treated with immunosuppression had serious adverse events. Conclusions: Immunosuppressive treatments do not modify the unfavorable prognosis of patients with IgAN who are aged ≥50 years presenting with AKI-MH, and are frequently associated with severe complications.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute kidney injury ; Adverse events ; IgA nephropathy ; Immunosuppression ; Kidney failure ; Macroscopic hematuria
Publicat a:	Kidney International Reports, Vol. 8 Núm. 8 (august 2023) , p. 1596-1604, ISSN 2468-0249

DOI: 10.1016/j.ekir.2023.05.027
PMID: 37547537

9 p, 680.7 KB

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