Immunosuppressive treatment results in patients with primary IgA nephropathy in Turkiye; the data from TSN-GOLD working group

Figures & data

Figure 1. Study Flowchart.

Table 1. Demographic and baseline laboratory data of patients according to initial immunosuppressive treatment protocol.

	All patients (n:408)	Corticosteroid (n:288)	Combined IST (n:120)	p
Age (years)	36.8 (17.1–72.6)	36.8 (17.2–72.6)	36.4 (17.1–71.9)	0.491^a
Gender (n, M/F)	267/141	189/99	78/42	0.904^b
Hypertension, n(%)	154 (37.7)	115(39.9)	39 (32.5)	0.158^b
Diabetes mellitus, n(%)	32 (7.8)	23(8)	9(7.5)	0.868^b
Smoker, n(%)	56 (13.7)	40(13.9)	16 (13.3)	0.921^b
Systolic blood pressure (mmHg)	130 (90–200)	130 (100–200)	130 (90–200)	0.080^a
Diastolic blood pressure (mmHg)	80 (50–180)	80 (50–120)	80 (50–180)	0.610^a
Mean Arterial pressure (mmHg)	96.7 (70–160)	96.7 (73–147)	96.7 (70–160)	0.227^a
Biopsy indication
Asymptomatic urinary abnormalities	85(20.8)	62(21.5)	23 (19.2)
Nephrotic Syndrome	133 (32.6)	91 (31.6)	42 (35)	0.971^c
Nephritic Syndrome	132 (32.4)	93 (32.3)	39 (32.5)
Mixed Nephrotic syndrome	39 (9.6)	29 (10.1)	10(8.3)
Other	16 (3.9)	11 (3.8)	5 (4.2)
Unknown	3 (0.7)	2 (0.7)	1 (0.8)
Body mass ındex (kg/m²)	26.1 (15.9–42.2)	26 (15.9–42.2)	26.1 (18.1–40)	0.798^a
Glucose (mg/dL)	92 (43–308)	92 (61–308)	92 (43–250)	0.689^a
Urea (mg/dL)	42 (2–187)	41 (2–143)	42 (8–187)	0.499^a
Creatinine (mg/dL)	1.2 (0.1–2.9)	1.2 (0.1–2.8)	1.3 (0.1–2.9)	0.181^a
eGFR (mL/min/1.73 m²)	68 (30.1–246.9)	70.4 (30.2–246.9)	66.4 (30.1–212.6)	0.163^a
Uric acid (mg/dL)	6.8 ± 1.8	6.8 ± 1.8	6.7 ± 1.8	0.529^d
Total cholesterol (mg/dL)	221.5 (92–586)	222 (92–489)	219.5 (100–586)	0.926^a
Triglyceride (mg/dL)	168(52–999)	166.5 (52–999)	176 (53–746)	0.955^a
HDL (mg/dL)	45 (22–287)	45 (23–156)	45 (22–287)	0.903^a
LDL (mg/dL)	142 (11–457)	143 (11–400)	139 (44–457)	0.553^a
Total protein (g/dL)	6.7 (3.3–8.7)	6.8 (3.3–8.5)	6.6 (3.4–8.7)	0.180^a
Albumin (g/dL)	3.8 (1.2–7)	3.8 (1.2–7)	3.8 (1.6–4.9)	0.310^a
Hemoglobin (g/dL)	13.4 (1.8–43.3)	13.5 (1.8–43.3)	13.1 (8.2–18.4)	0.143^a
Hematocrit (%)	39.7 ± 5.4	39.9 ± 5.4	39 ± 5.4	0.116^d
Proteinuria (mg/day)	2800 (750–23,304)	2596.5 (790–23,304)	3365 (750–10,885)	0.007^a
Pyuria, n(%)	74 (18.8)	48 (17.5)	26 (22)	0.287^b
Hematuria, n(%)	299 (73.8)	215 (75.2)	84 (70.6)	0.339^b
Mesangial proliferation (%) MO/M1	15.9/84.1	14.6/85.4	18.8/81.2	0.332^b
Endocapillary hypercellularity (%) E0/E1	63.4/36.6	66/34	57.4/42.6	0.108^b
Segmental glomerulosclerosis (%) S0/S1	42.4/57.6	39/61	50.4/49.6	0.036^b
Tubular atrophy /interstitial fibrosis (%) T0/T1/T2	40.4/52/7.6	43.4/50/6.6	33.3/56.9/9.8	0.182^b
Crescent (%) C0/C1/C2	71.2/23.7/5.1	73.2/22.4/4.4	66.7/26.5/6.8	0.369^b

M: male; F: female; eGFR: estimated glomerular filtration rate.

Statistical significance is set at p < 0.05 (in bold). The data were expressed as median (minimum: maximum), mean ± standard deviation and n%.

^aMann–Whitney U-test, ^bChi-Square test, ^cFisher-Freeman-Halton test, ^dIndependent sample t-test.

Table 2. Treatment responses.

	All patients (n:408)	Corticosteroid (n:288)	Combined (n:120)	p
Treatment response (%)				*0.016
No-remission	25.3	22	33.3
Remission	74.7	78*	66.7
Partial	66.3	69.4	57.7
Complete	33.7	30.6	42.3

Statistical significance is set at p < 0.05 (in bold). Data are presented as n (%).

Table 3. Laboratory and demographic data of patients according to treatment responses.

	Remission (n:304)	No-remission (n:104)	p
Age (years)	36.8 (17.1–72.6)	36.8 (19.1–68.9)	0.650^a
Gender (n, M/F)	201/103	67/37	0.706^b
Hypertension, n(%)	112 (36.8)	42 (40.8)	0.477^b
Diabetes mellitus, n(%)	25 (8.2)	7 (6.8)	0.642^b
Cigarette smoker, n(%)	43 (13.3)	25 (18.8)	0.167^b
Systolic blood pressure (mmHg)	130 (90–200)	135 (100–192)	0.037^a
Diastolic blood pressure (mmHg)	80 (50–120)	80 (60–180)	0.055^a
Mean arteriel pressure (mmHg)	96.7 (70–147)	100 (78–160)	0.018^a
Body mass index (kg/m²)	26.2 (15.9–42.2)	25.7 (18.1–40.2)	0.328^a
Creatinine (mg/dL)	1.2 (0.1–2.7)	1.3 (0.1–2.9)	0.191^a
eGFR (mL/min/1.73 m^2)	72.1 (30.6–246.9)	64.6 (30.1–212.6)	0.130^a
Proteinuria (mg/gün)	2700 (750–23,304)	3130 (1012–12,644)	0.005^a
Leukocyturia, n(%)	49 (16.8)	25 (25)	0.070^b
Hematuria, n(%)	222 (73.8)	76 (73.8)	0.995^b
Mesangial proliferation (%) M0/M1	14.9/85.1	18.3/81.7	0.454^b
Endocapillary hypercellularity (%)   E0/E1	64.3/35.7	60.6/39.4	0.514^b
Segmental glomerulosclerosis (%)   S0/S1	39.6/60.4	51/49	0.047^b
Tubular atrophy/interstitial fibrosis (%)   T0/T1/T2	42.6/51.8/5.6	34.7/52.6/12.6	0.063^b
Crescent (%)   C0/C1/C2	69.1/25.3/5.6	77/19/4	0.323^b

M: male, F: female, eGFR: estimated glomerular filtration rate.

Statistical significance is set at p < 0.05 (in bold). The data were expressed as median (minimum: maximum) and n%.

^aMann–Whitney U test, ^bChi-Square test.

Figure 2. Remission rates of other immunosuppressive protocols. CS: corticosteroid, CYS: cyclophosphamide, MMF: mycophenolate mofetil, CNI: calcineurin inhibitor, AZA: azathioprine.

Figure 3. Cumulative incidence of primary outcome, remission, according to remission-associated risk factors during follow-ups. CI: Confidence Interval.

Table 4. Analysis of factors associated with remission by multivariate cox regression.

	Univariable cox regression model			Multivariate cox regression model
	Wald	HR(%95CI)	p Value	Wald	HR(%95CI)	p Value
Age	0.97	1.01 (0.99:1.01)	0.325
Serum creatinine (mg/dL)	0.99	1.13 (0.89:1.43)	0.318
Proteinuria (mg/d)	0.08	1.06 (0.71:1.58)	0.779
Mesangial proliferation (M1)	2.47	1.35 (0.93:1.95)	0.116
Endocapillary hypercellularity (E1)	0.43	1.09 (0.84:1.41)	0.513
Segmental glomerulosclerosis (S1)	6.85	1.38 (1.08:1.77)	0.009	6.19	1.43 (1.08:1.89)	0.013
Tubular atrophy /interstitial fibrosis (T0)
T1	5.8	0.72 (0.55:0.94)	0.016	7.04	0.68 (0.51:0.91)	0.008
T2	0.04	0.94 (0.54:1.65)	0.835	0.09	0.80 (0.51:1.63)	0.759
Crescent (C0)
C1	0.06	1.04 (0.78:1.37)	0.805
C2	0.12	1.09 (0.65:1.86)	0.728
Immunosuppressive (Just KS)
KS-Other	11.3	0.63 (0.48:0.82)	0.001	6.73	0.66 (0.49:0.91)	0.009

HR: Hazard ratio; CI: confidence interval; CS: corticosteroids; IST: immunosuppressive treatment.

‘M0’ for Mesangial proliferation, ‘E0’ for Endocapillary hypercellularity, ‘S0’ for Segmental glomerulosclerosis, ‘T0’ for Tubular atrophy/interstitial fibrosis, and ‘C0’ for Crescent were determined as the reference category.

Cox regression model is significant (p < 0.001), Statistical significance is set at p < 0.05 (in bold).