NDT Advance Access originally published online on December 12, 2006
Nephrology Dialysis Transplantation 2007 22(3):778-783; doi:10.1093/ndt/gfl704
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Insulin resistance and the progression of IgA glomerulonephritis
1Department of Internal Medicine, Tampere University Hospital, Tampere, 2Department of Laboratory Medicine, Central Hospital of Savonlinna, Savonlinna, 3Department of Internal Medicine, Medical School, 4School of Public Health, University of Tampere, Tampere and 5Department of Laboratory Medicine, Central Hospital of Seinäjoki, Seinäjoki, Finland
Correspondence and offprint requests to: Kati Kaartinen, MD, Kalevankatu 21 B 31, FIN-00100 Helsinki, Finland. Email: kati.kaartinen{at}pp.inet.fi
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Abstract |
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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.
Keywords: cystatin-C; HOMA-IR; IgA glomerulonephritis; insulin; progression
Received for publication: 21. 5.06
Accepted in revised form: 31.10.06
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