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Time-averaged proteinuria during follow-up and renal prognosis in patients with biopsy-proven benign nephrosclerosis

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Abstract

Background

Heavy proteinuria at diagnostic renal biopsy has been reported as an independent risk factor for deteriorating renal function in benign nephrosclerosis (BNS). However, studies investigating the relationship between the amount of proteinuria during follow-up and long-term renal prognosis in BNS are limited. This study aimed to assess the relationship between time-averaged proteinuria (TAP) and renal prognosis in BNS.

Methods

The study participants included 98 patients with biopsy-proven BNS (average age 52 ± 13 years, estimated glomerular filtration rate (eGFR) 53 ± 25 ml/min/1.73 m2, urine protein excretion at baseline 1.34 ± 1.30 g/gCr) from the Jikei University Hospital. Multivariate analysis was used to investigate the effects of TAP and other clinicopathological findings on the risk for renal outcome in biopsy-proven BNS (a 30% decline in eGFR from baseline or end-stage renal disease). Proteinuria was measured every 6 months and the mean value was used as an indicator of TAP.

Results

The average observation period was 56 ± 43 months. In the unadjusted model, higher levels of TAP and urinary protein at baseline, glomerulosclerosis, and tubulointerstitial damage were associated with renal prognosis. The adjusted model demonstrated a significant association between TAP and renal outcomes (hazard ratio 5.45, 95% confidence interval 3.02–10.7), which was independent of higher baseline proteinuria, glomerulosclerosis, and tubulointerstitial damage.

Conclusions

TAP is an independent risk factor for renal prognosis in patients with BNS, indicating the significance of urinary protein excretion during follow-up for the progression of BNS. Clinicians should understand the importance of follow-up evaluation for proteinuria in patients with BNS.

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Data availability

The datasets generated and analyzed during the study are not publicly available due to the terms of consent to which the participants agreed, but the datasets generated and/or analyzed during the current study are available upon request from the corresponding author.

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Acknowledgements

We thank all staff, who were part of the Division of Nephrology and Hypertension, The Jikei University School of Medicine, for their comments and technical assistance.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Hoichi Amano, Kentaro Koike, Kotaro Haruhara, Nobuo Tsuboi, Makoto Ogura & Takashi Yokoo

  2. Graduate School of Public Health, Teikyo University, Tokyo, Japan

    Hoichi Amano

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  1. Hoichi Amano
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  2. Kentaro Koike
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  3. Kotaro Haruhara
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  4. Nobuo Tsuboi
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  5. Makoto Ogura
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  6. Takashi Yokoo
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Correspondence to Kentaro Koike.

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All authors declare that there is no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at the Jikei University hospital (approval number 29-110), where the studies were conducted and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All patients included in this study provided their written informed consent for performing the renal biopsy and analyzing the data.

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Amano, H., Koike, K., Haruhara, K. et al. Time-averaged proteinuria during follow-up and renal prognosis in patients with biopsy-proven benign nephrosclerosis. Clin Exp Nephrol 24, 688–695 (2020). https://doi.org/10.1007/s10157-020-01885-w

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  • DOI: https://doi.org/10.1007/s10157-020-01885-w

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