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Longitudinal change in proteinuria and kidney outcomes in C3 glomerulopathy

2021; Oxford University Press; Volume: 37; Issue: 7 Linguagem: Inglês

10.1093/ndt/gfab075

1460-2385

Fernando Caravaca‐Fontán, Montserrat Díaz-Encarnación, Virginia Cabello, Gema Ariceta, Luís F. Quintana, Helena Marco, Xoana Barros, Natàlia Ramos, Nuria Rodríguez-Mendiola, Sonia Cruz, Gema Fernández‐Juárez, A. Bernardos Rodríguez, Ana Pérez de José, Cristina Rabasco, Raquél Rodado, Loreto Fernández, María Vanessa Pérez-Gómez, Ana Ávila, Luis Eduardo Bravo, N. Espinosa, Natalia Allende, María Dolores Sánchez de la Nieta, Eva Rodríguez, Teresa Olea, Marta Melgosa, Ana Huerta, Rosa Miquel, Carmen Mon, Gloria Fraga, Alberto de Lorenzo, Juliana Draibe, Marta Cano-Megías, Fayna González, Amir Shabaka, Maria Esperanza López-Rubio, María Ángeles Fenollosa, Luis Martín‐Penagos, Iara Da Silva, Juana Alonso Titos, Santiago Rodrı́guez de Córdoba, Elena Goicoechea de Jorge, Manuel Praga,

Renal Transplantation Outcomes and Treatments

The association between a change in proteinuria over time and its impact on kidney prognosis has not been analysed in complement component 3 (C3) glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure.This was a retrospective, multicentre observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modelling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure.The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13-41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (hazard ratio 0.79; 95% confidence interval 0.56-0.97; P < 0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up.The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.