engleski

FACTORS INFLUENCING CLINICAL OUTCOME IN PATIENTS WITH PRIMARY GLOMERULONEPHRITIS

INTRODUCTION AND AIMS: Primary glomerulonephritis (PGN) is one of the leading causes of chronic kidney disease (CKD). A difference in outcome exists among different PGN subtypes. However, clinical course might be additionally affected with other well established general risk factors for CKD. The aim of our study was to analyse effect of various risk factors on clinical course and outcome which were presented in patients before PGN became clinically manifested. METHODS: Data on 745 adult PGN patients (age median 40.0 (IQR: 28-55) yrs. men 64.5%) were determined. Blood pressure (BP) was measured following ESH/ESC guidelines at the time when kidney biopsy was performed but before starting immunosuppressive therapy. GFR was estimated using MDRD formula. Nephrotic proteinuria (NP) was considered as >3.5g/day. Hypertension (HT) was defined as BP > 140/90 mmHg in patients without nephrotic proteinuria and BP > 130/85 mmHg in patients with NP and/or taking antihypertensive drugs. Data on smoking, HT duration, antihypertensive therapy and presence of CKD (eGFR less than 60 ml/min/1.73 m2). Therapy outcome was defined as complete remission (proteinuria less than 0.25 g/dU) (CR), partial remission (proteinuria 0.25-3 g/dU) (PR), therapy failure (TF) (proteinuria more than 3 g/dU) and haemodialysis (HD). Patients were treated according to the KDIGO recommendations. RESULTS: In the whole group of patients CR was achieved in 44.23%, PR in, 34.18% and TF in PR, 16.79% patients. 4.8% had to start with dialysis. Age was a significant predictor of outcome decreasing odds for CR compared to TF by 2.4% with each year (OR 0.976 [0.966-0, 989]). Sex, HT at the time of biopsy and prior to biopsy, BMI and smoking did not influence the outcome (all p>0.05). Age and sex-adjusted pulse pressure strongly determined the outcome by decreasing chances for CR compared to TF by 2.1% for each 1 mmHg (OR 0.979 [0.962-0.997]). Patients with CKD prior to kidney biopsy had OR for CR of 0.45 [0.28, 0.73], while patients who were taking ACE-inhibitors had better outcome and higher odds for CR(OR 2.07 [1.06, 4.03]). CONCLUSIONS: Age, pulse pressure and CKD prior clinical manifestation of PGN are most important determinants of clinical outcome in the whole PGN group. Interestingly, HT, BMI, smoking and gender were not found to have significant impact on clinical course. Treatment with ACE inhibitors before clinical manifestation of PGN has beneficial (protective) effect.

primary glomerulonephritis; risk factors

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