Improved Renal Function in Initial Treatment Improves Patient Survival, Renal Outcomes, and Glucocorticoid-Related Complications in IgG4-Related Kidney Disease in Japan
Introduction: We aimed to clarify long-term renal prognosis, complications of malignancy, glucocorticoid (GC) toxicity, and mortality in immunoglobulin G4 (IgG4)-related kidney disease (IgG4-RKD). Methods: Reviewing the medical records of 95 patients with IgG4-RKD, we investigated clinical and patho...
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Elsevier
2024-01-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024923015565 |
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| author | Ichiro Mizushima Takako Saeki Daisuke Kobayashi Naoki Sawa Hiroki Hayashi Yoshinori Taniguchi Hirosuke Nakata Kazunori Yamada Shoko Matsui Tetsuhiko Yasuno Kosuke Masutani Tasuku Nagasawa Hiroki Takahashi Yoshifumi Ubara Motoko Yanagita Mitsuhiro Kawano |
| author_facet | Ichiro Mizushima Takako Saeki Daisuke Kobayashi Naoki Sawa Hiroki Hayashi Yoshinori Taniguchi Hirosuke Nakata Kazunori Yamada Shoko Matsui Tetsuhiko Yasuno Kosuke Masutani Tasuku Nagasawa Hiroki Takahashi Yoshifumi Ubara Motoko Yanagita Mitsuhiro Kawano |
| author_sort | Ichiro Mizushima |
| collection | DOAJ |
| description | Introduction: We aimed to clarify long-term renal prognosis, complications of malignancy, glucocorticoid (GC) toxicity, and mortality in immunoglobulin G4 (IgG4)-related kidney disease (IgG4-RKD). Methods: Reviewing the medical records of 95 patients with IgG4-RKD, we investigated clinical and pathologic features at baseline, the course of renal function, complications of malignancy, GC toxicity, and mortality during follow-up (median 71 months). The standardized incidence ratio (SIR) of malignancy and standardized mortality ratio were calculated using national statistics. Factors related to outcomes were assessed by Cox regression analyses. Results: At diagnosis, the median estimated glomerular infiltration rate (eGFR) was 46 ml/min per 1.73 m2. GC achieved initial improvement. Additional renal function recovery within 3-months of initial treatment occurred in patients with highly elevated serum IgG and IgG4 levels and hypocomplementemia. During follow-up, 68%, 17%, and 3% of the patients had chronic kidney disease (CKD), >30% eGFR decline, and end-stage renal disease (ESRD), respectively. Age-adjusted and sex-adjusted Cox regression analyses indicated that eGFR (hazard ratio [HR], 0.71) and extensive fibrosis (HR, 2.58) at treatment initiation had a significant impact on the time to CKD. Ten patients died, and the standardized mortality ratio was 0.94. The SIR of malignancy was 1.52. The incidence rate (IR) of severe infection was 1.80/100 person-years. Cox regression analyses showed that the best eGFR within 3 months after treatment initiation were associated with lower mortality (HR 0.67) and fewer severe infections (HR 0.63). Conclusion: This study suggests that more renal function recovery through early treatment initiation may improve patient survival, renal outcomes, and some GC-related complications in IgG4-RKD. |
| format | Article |
| id | doaj-art-12ad52aeaae64a4e8cfb2ec3ad25cac1 |
| institution | OA Journals |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-12ad52aeaae64a4e8cfb2ec3ad25cac12025-08-20T02:06:11ZengElsevierKidney International Reports2468-02492024-01-0191526310.1016/j.ekir.2023.10.016Improved Renal Function in Initial Treatment Improves Patient Survival, Renal Outcomes, and Glucocorticoid-Related Complications in IgG4-Related Kidney Disease in JapanIchiro Mizushima0Takako Saeki1Daisuke Kobayashi2Naoki Sawa3Hiroki Hayashi4Yoshinori Taniguchi5Hirosuke Nakata6Kazunori Yamada7Shoko Matsui8Tetsuhiko Yasuno9Kosuke Masutani10Tasuku Nagasawa11Hiroki Takahashi12Yoshifumi Ubara13Motoko Yanagita14Mitsuhiro Kawano15Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan; Correspondence: Ichiro Mizushima, Department of Rheumatology, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8640, Japan.Department of Internal Medicine, Nagaoka Red Cross Hospital, Nagaoka, JapanDivision of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, JapanDepartment of Nephrology Center, Toranomon Hospital, Kawasaki, JapanDepartment of Nephrology, Fujita Health University School of Medicine, Toyoake, JapanDepartment of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi University, Nankoku-shi, JapanDepartment of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto City, JapanDepartment of Hematology and Immunology, Kanazawa Medical University, Kahoku-gun, JapanHealth Administration Center, University of Toyama, Toyama City, JapanDivision of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Jonan-Ku, JapanDivision of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Jonan-Ku, JapanDivision of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai, JapanDepartment of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, JapanDepartment of Nephrology Center, Toranomon Hospital, Kawasaki, JapanDepartment of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto City, JapanDepartment of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa, JapanIntroduction: We aimed to clarify long-term renal prognosis, complications of malignancy, glucocorticoid (GC) toxicity, and mortality in immunoglobulin G4 (IgG4)-related kidney disease (IgG4-RKD). Methods: Reviewing the medical records of 95 patients with IgG4-RKD, we investigated clinical and pathologic features at baseline, the course of renal function, complications of malignancy, GC toxicity, and mortality during follow-up (median 71 months). The standardized incidence ratio (SIR) of malignancy and standardized mortality ratio were calculated using national statistics. Factors related to outcomes were assessed by Cox regression analyses. Results: At diagnosis, the median estimated glomerular infiltration rate (eGFR) was 46 ml/min per 1.73 m2. GC achieved initial improvement. Additional renal function recovery within 3-months of initial treatment occurred in patients with highly elevated serum IgG and IgG4 levels and hypocomplementemia. During follow-up, 68%, 17%, and 3% of the patients had chronic kidney disease (CKD), >30% eGFR decline, and end-stage renal disease (ESRD), respectively. Age-adjusted and sex-adjusted Cox regression analyses indicated that eGFR (hazard ratio [HR], 0.71) and extensive fibrosis (HR, 2.58) at treatment initiation had a significant impact on the time to CKD. Ten patients died, and the standardized mortality ratio was 0.94. The SIR of malignancy was 1.52. The incidence rate (IR) of severe infection was 1.80/100 person-years. Cox regression analyses showed that the best eGFR within 3 months after treatment initiation were associated with lower mortality (HR 0.67) and fewer severe infections (HR 0.63). Conclusion: This study suggests that more renal function recovery through early treatment initiation may improve patient survival, renal outcomes, and some GC-related complications in IgG4-RKD.http://www.sciencedirect.com/science/article/pii/S2468024923015565deathglucocorticoidIgG4-related kidney diseasemalignancyoutcometreatment |
| spellingShingle | Ichiro Mizushima Takako Saeki Daisuke Kobayashi Naoki Sawa Hiroki Hayashi Yoshinori Taniguchi Hirosuke Nakata Kazunori Yamada Shoko Matsui Tetsuhiko Yasuno Kosuke Masutani Tasuku Nagasawa Hiroki Takahashi Yoshifumi Ubara Motoko Yanagita Mitsuhiro Kawano Improved Renal Function in Initial Treatment Improves Patient Survival, Renal Outcomes, and Glucocorticoid-Related Complications in IgG4-Related Kidney Disease in Japan Kidney International Reports death glucocorticoid IgG4-related kidney disease malignancy outcome treatment |
| title | Improved Renal Function in Initial Treatment Improves Patient Survival, Renal Outcomes, and Glucocorticoid-Related Complications in IgG4-Related Kidney Disease in Japan |
| title_full | Improved Renal Function in Initial Treatment Improves Patient Survival, Renal Outcomes, and Glucocorticoid-Related Complications in IgG4-Related Kidney Disease in Japan |
| title_fullStr | Improved Renal Function in Initial Treatment Improves Patient Survival, Renal Outcomes, and Glucocorticoid-Related Complications in IgG4-Related Kidney Disease in Japan |
| title_full_unstemmed | Improved Renal Function in Initial Treatment Improves Patient Survival, Renal Outcomes, and Glucocorticoid-Related Complications in IgG4-Related Kidney Disease in Japan |
| title_short | Improved Renal Function in Initial Treatment Improves Patient Survival, Renal Outcomes, and Glucocorticoid-Related Complications in IgG4-Related Kidney Disease in Japan |
| title_sort | improved renal function in initial treatment improves patient survival renal outcomes and glucocorticoid related complications in igg4 related kidney disease in japan |
| topic | death glucocorticoid IgG4-related kidney disease malignancy outcome treatment |
| url | http://www.sciencedirect.com/science/article/pii/S2468024923015565 |
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