Nur Ezzaty Binti Mohammad Kazmin, Nur Ezzaty Binti Mohammad Kazmin (2020) LONG TERM OUTCOME OF IMMUNOGLOBULIN A (IgA) NEPHROPATHY: A SINGLE CENTRE EXPERIENCE. Masters thesis, Universiti Kebangsaan Malaysia.
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LONG TERM OUTCOME OF IMMUNOGLOBULIN A (IgA) NEPHROPATHY.pdf Restricted to Registered users only Download (439kB) |
Abstract
Introduction IgA Nephropathy (IgA N) has heterogenous presentation and progression to End Stage Renal Disease (ESRD) contributed by demographics, ethnicity, and treatment regimen. We investigated long term survival of IgA N patients in our centre and factors affecting it. Methods All biopsy proven IgA N patients with > 1year follow-up excluded patients with diabetes mellitus at diagnosis and secondary IgA N. Medical records were reviewed for demographics, presentation, blood pressure, 24-hour urine protein, serum creatinine, renal biopsy and treatment received. Primary outcome was defined as combined event of 50% estimated glomerular filtration rate (eGFR) reduction or ESRD. Results We included 130 (74 females; 56 male) patients with mean age 38.0 ± 14.0 years and median eGFR of 75.2 (IQR 49.3-101.4) ml/min/1.73m2. Eighty-four (64.6%) were hypertensive at presentation, 35 (26.9%) with nephrotic syndrome and 57 (43.8%) with nephrotic range proteinuria (NRP). Median follow-up was 7.5 (IQR 4.0-13.0) years with 18 (13.8%) developed ESRD and 34 (26.2%) reached primary outcome. Annual eGFR decline was -2.1 (IQR -5.3 to -0.1) ml/min/1.73m2/year, with median survival of 20 years. Renal survival at 10, 20 and 30 years was 80%, 53% and 25%, while survival against ESRD was 87%, 73% and 65% respectively. In the univariate analysis; time-average proteinuria (HR = 2.41, 95% CI 1.80-3.30), eGFR at biopsy (HR = 2.35, 95% CI 1.03-5.32), hypertension (HR = 2.81, 95% CI 1.16-6.80), mean arterial pressure (HR = 1.02, 95% CI 1.01-1.03), tubular atrophy/interstitial fibrosis score (HR = 3.765, 95% CI 1.84-7.73), and cellular/ fibrocellular crescent score, (HR = 2.44, 95% CI 1.19 -5.00), were found to be significant while only time-average proteinuria (TA-proteinuria) remained significant predictor at multivariate analysis (HR = 2.23, 95% CI 1.57-3.16). Conclusion TA-proteinuria was the most important predictor in progression of IgA N in our cohort irrespective of degree of proteinuria at presentation.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Universiti > Universiti Kebangsaan Malaysia (UKM) |
| Depositing User: | Encik Mohd Zulkarnain Hassan bin Mohd Zainudin |
| Date Deposited: | 12 Dec 2025 11:09 |
| Last Modified: | 12 Dec 2025 11:09 |
| URI: | https://repositori.mohe.gov.my/id/eprint/135 |
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