Optimal timing of proteinuria remission after treatment initiation in childhood IgA Nephropathy

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https://storage.unitedwebnetwork.com/files/1099/5efc2f406cac56477d149bd14cd0ee43.pdf

Abstract Title *

Optimal timing of proteinuria remission after treatment initiation in childhood IgA Nephropathy

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Co-author 1

Yuko Shima yukotk@wakayama-med.ac.jp Wakayama Medical Unuversity Pediatrics Wakayama Japan *

Co-author 2

Hironobu Mukaiyama hmukaiyama@hashimoto-hsp.jp Wakayama Medical University Pediatrics Wakayama Japan -

Co-author 3

Yu Tanaka tanaka-y@wakayama-med.ac.jp Wakayama Medical University Pediatrics Wakayama Japan -

Co-author 4

Wataru Shimabukuro h200152@cs.u-ryukyu.ac.jp Graduate School of Medicine, University of the Ryukyus Department of Child Health and Welfare (Pediatrics) Ginowan Japan -

Co-author 5

Hiroshi Kaito hskaitou_kch@hp.pref.hyogo.jp Hyogo Prefectural Kobe Children’s Hospital Department of Nephrology Kobe Japan -

Co-author 6

Ryojiro Tanaka tanaka_kch@hp.pref.hyogo.jp Hyogo Prefectural Kobe Children’s Hospital Department of Nephrology Kobe Japan -

Co-author 7

Kandai Nozu nozu@med.kobe-u.ac.jp Kobe University Graduate School of Medicine Department of Pediatrics Kobe Japan -

Co-author 8

Kazumoto Iijima iijima@med.kobe-u.ac.jp Kobe University Graduate School of Medicine Department of Pediatrics Kobe Japan -

Co-author 9

Daisuke Tokuhara tokuhara@wakayama-med.ac.jp Wakayama Medical University Pediatrics Wakayama Japan -

Co-author 10

Norishige Yoshikawa yoshikawanori@gmail.com Takatsuki General Hospital Clinical Research Center Takatsuki Japan -

Co-author 11

Koichi Nakanishi knakanis@cs.u-ryukyu.ac.jp Graduate School of Medicine, University of the Ryukyus Department of Child Health and Welfare (Pediatrics) Ginowan Japan -

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Proteinuria remission is the most significant prognostic factor in childhood IgA nephropathy (c-IgAN). However, the time required to achieve proteinuria remission after treatment initiation varies among patients, depending on clinical presentation, histopathological findings, and treatment modalities. Clinicians often face uncertainty in determining whether to continue current therapy or modify the treatment plan based on the course of proteinuria. Clarifying the optimal timing for proteinuria remission may aid in clinical decision-making.

Methods

This study is a retrospective analysis of 538 Japanese biopsy-proven c-IgAN between 1976 and 2013. To identify the optimal timing of proteinuria remission after treatment initiation, we compared clinical characteristics between patients who achieved proteinuria remission and those who did not.

Results

Among 536 evaluable cases, 312 patients (58.2%) achieved proteinuria remission during a median follow-up of 5 years. The median time to remission was 2 years, regardless of initial proteinuria severity (heavy proteinuria vs. moderate proteinuria) or treatment (immunosuppressive vs. non-immunosuppressive), with no significant differences observed (p= 0.68, 0.83). The Kaplan-Meier analysis showed significant differences in CKD G3a-G5-free survival between the patients with proteinuria remission within 2 years of treatment initiation and no remission (p=0.03, log-rank test). There was no significant association between time to remission and risk of relapse (HR: 1.04 [95% CI: 0.95–1.12], p= 0.40). Among patients with heavy proteinuria at the start of treatment, those who achieved remission showed a significantly faster reduction in heavy proteinuria compared to non-remitters (median 1 year vs. 2 years, p <0.0001).

Conclusion

In Japanese c-IgAN, early detection through school urinary screening enables diagnosis at an early disease course. Timely and appropriate treatment based on disease severity, with improvement in heavy proteinuria within 1 year and achievement of proteinuria remission within 2 years of treatment initiation, contributes to better long-term kidney outcomes.

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