Background: The long-term prognosis of clinically early IgA nephropathy (IgAN) patients remains to be clarified.\nWe investigated the long-term outcomes of IgAN patients with an apparently benign presentation and evaluated\nprognostic factors for renal survival.\nMethods: We included patients with biopsy-proven IgAN who had estimated glomerular filtration rates\n(eGFR) ?60 mL/min/1.73 m2, normal blood pressure, and proteinuria <0.5 g/day at the time of biopsy. The primary\noutcome was progression to end-stage renal disease (ESRD). The secondary outcome was a 50% increase in serum\ncreatinine level or an increase in proteinuria to >1 g/day.\nResults: The analysis included 153 patients who met the inclusion criteria. At diagnosis, their median systolic\nblood pressure was 120 (110ââ?¬â??130) mmHg, eGFR was 85.9 (74.9ââ?¬â??100.1) mL/min/1.73 m2, and proteinuria was\n0.25 (0.13ââ?¬â??0.38) g/day. Of these, 4 patients died and 6 reached ESRD. The 30-year renal survival rate was 85.5%.\nThree patients had increased serum creatinine levels and 11 developed proteinuria. Remission was observed in\n35 (22.9%) patients. A moderate or severe degree of interstitial fibrosis (adjusted odd ratio [OR] 5.93, 95%\nconfidence interval [CI] 1.44ââ?¬â??24.45, P = 0.014) and hypoalbuminemia (adjusted OR 6.18, 95% CI 1.20ââ?¬â??31.79, P = 0.029)\nwere independent predictors of the secondary outcome.\nConclusions: This study showed that the prognosis of early IgAN was not always favorable, even resulting in\nprogression to ESRD in some cases. Hypoalbuminemia and interstitial fibrosis should also be considered\nimportant prognostic factors in clinically early IgAN patients.
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