Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy
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....
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2023 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:301122 |
| Acceso en línea: | https://ddd.uab.cat/record/301122 https://dx.doi.org/urn:doi:10.1016/j.ekir.2023.05.027 |
| Access Level: | acceso abierto |
| Palabra clave: | Acute kidney injury Adverse events IgA nephropathy Immunosuppression Kidney failure Macroscopic hematuria |
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Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA NephropathySevillano, Ángel M.Caravaca-Fontán, FernandoCordero Garcia-Galan, LucíaFernández-Juarez, GemaLópez-Revuelta, KatiaGuzmán, Diomaris A.Martín-Reyes, GuillermoQuintana, Luis F.|||0000-0001-7582-8476Rodas, Lidia M.Sánchez de la Nieta, María DoloresRabasco, CristinaEspinosa, MarioDíaz Encarnación, Montserrat Mercedes|||0000-0001-5172-3370San Miguel, LuzBarrios, Clara|||0000-0003-0492-4107Rodriguez, EvaGarcia, PatriciaValera, AlfonsoPeña, Jessy KorinaShabaka, Amir|||0000-0001-7039-4701Velo, MercedesSierra, MilagrosGonzalez, FaynaFernandez-Reyes, María JoséHeras, ManuelDelgado, PatriciaGutierrez, EduardoMoreno Gutiérrez, Juan Antonio|||0000-0002-7468-2871Praga, Manuel|||0000-0001-9270-1071Acute kidney injuryAdverse eventsIgA nephropathyImmunosuppressionKidney failureMacroscopic hematuriaMacroscopic 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.Universitat Autònoma de Barcelona 22023-01-0120232023-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/301122https://dx.doi.org/urn:doi:10.1016/j.ekir.2023.05.027reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest 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.https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:3011222026-06-06T12:50:31Z |
| dc.title.none.fl_str_mv |
Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy |
| title |
Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy |
| spellingShingle |
Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy Sevillano, Ángel M. Acute kidney injury Adverse events IgA nephropathy Immunosuppression Kidney failure Macroscopic hematuria |
| title_short |
Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy |
| title_full |
Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy |
| title_fullStr |
Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy |
| title_full_unstemmed |
Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy |
| title_sort |
Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy |
| dc.creator.none.fl_str_mv |
Sevillano, Ángel M. Caravaca-Fontán, Fernando Cordero Garcia-Galan, Lucía Fernández-Juarez, Gema López-Revuelta, Katia Guzmán, Diomaris A. Martín-Reyes, Guillermo Quintana, Luis F.|||0000-0001-7582-8476 Rodas, Lidia M. Sánchez de la Nieta, María Dolores Rabasco, Cristina Espinosa, Mario Díaz Encarnación, Montserrat Mercedes|||0000-0001-5172-3370 San Miguel, Luz Barrios, Clara|||0000-0003-0492-4107 Rodriguez, Eva Garcia, Patricia Valera, Alfonso Peña, Jessy Korina Shabaka, Amir|||0000-0001-7039-4701 Velo, Mercedes Sierra, Milagros Gonzalez, Fayna Fernandez-Reyes, María José Heras, Manuel Delgado, Patricia Gutierrez, Eduardo Moreno Gutiérrez, Juan Antonio|||0000-0002-7468-2871 Praga, Manuel|||0000-0001-9270-1071 |
| author |
Sevillano, Ángel M. |
| author_facet |
Sevillano, Ángel M. Caravaca-Fontán, Fernando Cordero Garcia-Galan, Lucía Fernández-Juarez, Gema López-Revuelta, Katia Guzmán, Diomaris A. Martín-Reyes, Guillermo Quintana, Luis F.|||0000-0001-7582-8476 Rodas, Lidia M. Sánchez de la Nieta, María Dolores Rabasco, Cristina Espinosa, Mario Díaz Encarnación, Montserrat Mercedes|||0000-0001-5172-3370 San Miguel, Luz Barrios, Clara|||0000-0003-0492-4107 Rodriguez, Eva Garcia, Patricia Valera, Alfonso Peña, Jessy Korina Shabaka, Amir|||0000-0001-7039-4701 Velo, Mercedes Sierra, Milagros Gonzalez, Fayna Fernandez-Reyes, María José Heras, Manuel Delgado, Patricia Gutierrez, Eduardo Moreno Gutiérrez, Juan Antonio|||0000-0002-7468-2871 Praga, Manuel|||0000-0001-9270-1071 |
| author_role |
author |
| author2 |
Caravaca-Fontán, Fernando Cordero Garcia-Galan, Lucía Fernández-Juarez, Gema López-Revuelta, Katia Guzmán, Diomaris A. Martín-Reyes, Guillermo Quintana, Luis F.|||0000-0001-7582-8476 Rodas, Lidia M. Sánchez de la Nieta, María Dolores Rabasco, Cristina Espinosa, Mario Díaz Encarnación, Montserrat Mercedes|||0000-0001-5172-3370 San Miguel, Luz Barrios, Clara|||0000-0003-0492-4107 Rodriguez, Eva Garcia, Patricia Valera, Alfonso Peña, Jessy Korina Shabaka, Amir|||0000-0001-7039-4701 Velo, Mercedes Sierra, Milagros Gonzalez, Fayna Fernandez-Reyes, María José Heras, Manuel Delgado, Patricia Gutierrez, Eduardo Moreno Gutiérrez, Juan Antonio|||0000-0002-7468-2871 Praga, Manuel|||0000-0001-9270-1071 |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Universitat Autònoma de Barcelona |
| dc.subject.none.fl_str_mv |
Acute kidney injury Adverse events IgA nephropathy Immunosuppression Kidney failure Macroscopic hematuria |
| topic |
Acute kidney injury Adverse events IgA nephropathy Immunosuppression Kidney failure Macroscopic hematuria |
| description |
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. |
| publishDate |
2023 |
| dc.date.none.fl_str_mv |
2 2023-01-01 2023 2023-01-01 |
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Article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
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article |
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https://ddd.uab.cat/record/301122 https://dx.doi.org/urn:doi:10.1016/j.ekir.2023.05.027 |
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https://ddd.uab.cat/record/301122 https://dx.doi.org/urn:doi:10.1016/j.ekir.2023.05.027 |
| dc.language.none.fl_str_mv |
Inglés eng |
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Inglés |
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eng |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by-nc-nd/4.0/ |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by-nc-nd/4.0/ |
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openAccess |
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application/pdf |
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