Insulin resistance and the progression of IgA glomerulonephritis

• Published in: Nephrology, dialysis, transplantation Vol. 22; no. 3; pp. 778 - 783
• Main Authors: Kaartinen, Kati, Syrjänen, Jaana, Pörsti, Ilkka, Harmoinen, Aimo, Pasternack, Amos, Huhtala, Heini, Niemelä, Onni, Mustonen, Jukka
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2007; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Associated diseases and complications; Biological and medical sciences; Biomarkers - blood; Biopsy; Cystatin C; Cystatins - blood; Diabetes. Impaired glucose tolerance; Disease Progression; Emergency and intensive care: renal failure. Dialysis management; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Follow-Up Studies; Glomerular Filtration Rate; Glomerulonephritis; Glomerulonephritis, IGA - blood; Glomerulonephritis, IGA - pathology; Glomerulonephritis, IGA - physiopathology; HOMA-IR; Humans; IgA glomerulonephritis; insulin; Insulin - blood; Insulin Resistance; Intensive care medicine; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prognosis; progression; Protease Inhibitors; Retrospective Studies; IgA glomerulonephritis; HOMA-IR; progression; insulin; cystatin-C; Kidney disease; Glomerulonephritis; Cystatin; IgA; Urinary system disease; Hemodialysis; Insulin; Extrarenal dialysis; Renal failure
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfl704

Background. IgA glomerulonephritis (IgAGN) has a highly variable prognosis with 15–40% of patients progressing to end-stage renal disease. Hypertension, proteinuria and renal insufficiency are risk factors associated with poor prognosis. The role of insulin resistance is unclear in IgAGN. Methods. From a retrospective cohort of IgAGN patients, a total of 174 patients (104 males) were invited for two visits at the clinic, 11 and 16 years (median times) after IgAGN was diagnosed in renal biopsy. Of all the patients, 63% had been diagnosed at least 10 years before the first visit. Progressive disease was defined as cystatin-C exceeding normal limits and showing over 20% elevation between the first and second visits, or kidney transplantation or start of dialysis. Plasma insulin, homeostasis model assessment of insulin resistance (HOMA-IR) index and cystatin-C were obtained for analysis from 118 patients. Results. IgAGN was progressive in 19.5% of the patients on the second visit. Insulin level and HOMA-IR of the first visit showed significant association with the progression of IgAGN (P = 0.019 and 0.005, respectively). Conclusions. Our results show that in addition to the known risk factors age, hypertension, proteinuria and hyperuricaemia, plasma insulin level and calculated HOMA-IR are associated with the progression of IgAGN.