Clinical outcomes and predictors for ESRD and mortality in primary GN.
OBJECTIVE
Relatively little is known about the long-term outcomes of different histologic types of primary glomerulonephritis in Asian populations.


METHODS
From 1993 to 2006, 987 patients undergoing renal biopsy were studied, and 580 patients (mean age=44.4 years, male=58.5%) with the four most common forms of glomerulonephritis (membranous nephropathy, focal and segmental glomerulosclerosis, IgA nephropathy, and minimal change disease) were selected for analysis. Median follow-up period was 5.9 (interquartile range=5.7) years.


RESULTS
The focal and segmental glomerulosclerosis group displayed the highest incidence of ESRD (25.8%) and the fastest decline of estimated GFR (4.6 ml/min per 1.73 m(2) per year). The IgA nephropathy group also had a higher rate of ESRD than the membranous nephropathy patients (19.2% versus 4.3%, P<0.001). In contrast, the membranous nephropathy group exhibited an overall death rate similar to the focal and segmental glomerulosclerosis group (17.2% versus 14.4%) but higher than the IgA nephropathy and minimal change disease patients (4.6% and 3.7%, respectively, P<0.001). The most powerful predictor for ESRD was focal and segmental glomerulosclerosis, whereas the strongest predictor for all-cause mortality was membranous nephropathy with higher proteinuria. Protectors against ESRD included male sex and higher hemoglobin.


CONCLUSIONS
Most predictors for ESRD and overall mortality found in this ethnic Chinese cohort were similar to other studies. However, some risk factors linked with distinct glomerular pathologies displayed differential clinical outcomes.
Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan.
Yu-Hsiang
YH
Chou
Yu-Chung
YC
Lien
Fu-Chang
FC
Hu
Wei-Chou
WC
Lin
Chih-Chin
CC
Kao
Chun-Fu
CF
Lai
Wen-Chih
WC
Chiang
Shuei-Liong
SL
Lin
Tun-Jun
TJ
Tsai
Kwan-Dun
KD
Wu
Yung-Ming
YM
Chen
D000328:Adult; D000368:Aged; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005922:Glomerulonephritis, IGA / Q000401:mortality / Q000473:pathology; D015433:Glomerulonephritis, Membranous / Q000401:mortality / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000401:mortality / Q000473:pathology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009402:Nephrosis, Lipoid / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000401:mortality; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
D015415:Biomarkers; D006454:Hemoglobins