title: Risk factors for persistent proteinuria after a 2-year combination therapy for severe childhood IgA nephropathy.
abstract: BACKGROUND
  Although a 2-year combination therapy is effective for severe childhood immunoglobulin A (IgA) nephropathy, proteinuria persists in some patients even after the treatment.
  
  
  METHODS
  Seventy-nine patients aged <18 years with IgA nephropathy in which >80 % of glomeruli showed mesangial proliferation were enrolled in the study. Risk factors for persistent proteinuria after combination therapy were investigated using multivariate logistic regression analysis.
  
  
  RESULTS
  Proteinuria (≥0.2 g/1.73 m(2)/day) persisted in 27 patients (34 %) after the combination therapy. Twenty-four-hour urinary protein excretion, rate of glomeruli with crescents, rate of glomeruli with segmental sclerosis and rate of glomeruli with global sclerosis at diagnosis were higher in patients with persistent proteinuria than those without. In the multivariate analysis, 24-h urinary protein excretion [odds ratio (OR) 6.9; 95 % confidence interval (CI) 2.1-27.8; p = 0.001] and rate of glomeruli with crescents (OR 3.8; 95 % CI 1.1-13.9; p = 0.03) were independent risk factors for persistent proteinuria. Analysis of the receiver operating characteristic curve demonstrated that the most accurate cut-off values to detect persistent proteinuria were a urinary protein excretion of 1.32 g/1.73 m(2)/day and a 14 % rate of glomeruli with crescents.
  
  
  CONCLUSIONS
  In our cohort, urinary protein excretion and rate of glomeruli with crescents at diagnosis were independent risk factors for persistent proteinuria after the combination therapy.
authors.affiliation: Department of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, 157-8535, Setagaya-ku, Tokyo, Japan, kamei-k@ncchd.go.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kamei
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ito
authors.forename: Kenji
authors.initials: K
authors.lastname: Ishikura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hataya
authors.forename: Masataka
authors.initials: M
authors.lastname: Honda
authors.forename: Kandai
authors.initials: K
authors.lastname: Nozu
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Iijima
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shima
authors.forename: Norishige
authors.initials: N
authors.lastname: Yoshikawa
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007564:Japan; D007678:Kidney Glomerulus / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D007166:Immunosuppressive Agents; D010726:Phosphodiesterase Inhibitors