Proteinuria Trajectory and Disease Progression in Children and Adults with IgA Nephropathy/Vasculitis
Bibliographic record
Abstract
Key Points Defining risk of kidney function loss in IgA nephropathy and IgA vasculitis with nephritis is important for patient counseling and risk-based enrollment of clinical trials. Proteinuria trajectory over 2 years can uniquely identify patients at risk of loss of kidney function or kidney failure. Children and adults with the highest levels of proteinuria had a higher risk of progressive kidney disease compared with those with intermediate levels. Background Identifying patients with IgA nephropathy at risk of disease progression is critical for clinical decision making, risk-based patient counseling, and optimal enrollment of clinical trials. Methods Patients with IgA nephropathy and IgA vasculitis with nephritis were enrolled in the Cure Glomerulonephropathy Network, a multicenter observational cohort study. Children and adults were analyzed separately in four cohorts: ( 1 ) full, ( 2 ) incident, ( 3 ) prevalent, and ( 4 ) histology. Groups were defined using latent class trajectory modeling using proteinuria measurements over 2 years. Linear mixed models were used to calculate predicted eGFR slope. In adults, Cox proportional hazard models were used to model time to kidney failure or 40% eGFR decline as a function of the proteinuria trajectory group. Results Of 919 patients with IgA nephropathy/IgA vasculitis with nephritis enrolled into the Cure Glomerulonephropathy Network, 368 adults and 234 children were included in the analysis. In the full adult cohort, group 1 had the lowest levels of proteinuria (interquartile range [IQR], 0.1–0.4 g/g), while groups 2 and 3 had intermediate and higher levels of proteinuria (IQR, 0.5–1.5 and IQR, 1.8–4.1 g/g), respectively. The average predicted time to eGFR <15 ml/min per 1.73 m 2 was >90, 16, and 8 years and >90, 67, and 11 years for proteinuria trajectory groups 1, 2, and 3 in the full adult and pediatric cohorts, respectively. In adults, adjusting for age, eGFR at enrollment, immunosuppression exposure, and hypertension, group 3 membership was associated with 3.13 (95% confidence interval [CI], 1.84 to 5.33), 1.98 (95% CI, 0.97 to 4.06), and 3.36 (95% CI, 1.59 to 7.13) times higher hazard of progressing to a composite outcome compared with group 2 membership in the full, prevalent, and histology cohorts, respectively, but not associated with progression in the incident cohort. Conclusions Proteinuria trajectory is a major predictor of disease progression in patients with IgA nephropathy.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".