The Impact of Obesity on the Severity of Clinicopathologic Parameters in Patients with IgA Nephropathy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Source
2.2. Data Collection and Definitions
2.3. Histopathologic Parameters
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Study Subjects Stratified by BMI
3.2. Histopathologic Findings of the Study Subjects Stratified by BMI
3.3. Association between BMI and Histopathologic Parameters
3.4. Association of BMI with Clinical Variables, Renal Function, and Proteinuria
3.5. Treatment Patterns of the Study Subjects Stratified by BMI
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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BMI | ||||
---|---|---|---|---|
<18.5 kg/m2 (n = 32) | 18.5–24.9 kg/m2 (n = 312) | ≥25 kg/m2 (n = 193) | p | |
Age (year) | 34.3 ± 14.8 | 40.0 ± 15.2 * | 44.1 ± 13.3 * | <0.001 |
Sex (male, %) | 15 (46.9) | 140 (44.9) | 105 (54.4) | 0.112 |
Alcohol (yes, %) | 7 (21.9) | 56 (17.9) | 39 (20.3) | 0.737 |
Smoking (yes, %) | 7 (21.9) | 42 (13.5) | 35 (18.7) | 0.219 |
Diabetes mellitus (%) | 3 (9.4) | 14 (4.5) | 15 (7.8) | 0.218 |
Hypertension (%) | 5 (15.6) | 75 (24.0) | 74 (38.5) | 0.001 |
BMI (kg/m2) | 17.7 ± 0.7 | 22.0 ± 1.7 * | 28.5 ± 3.1 *,† | <0.001 |
SBP (mmHg) | 115.5 ± 15.5 | 122.9 ± 16.5 * | 127.8 ± 14.5 * | <0.001 |
DBP (mmHg) | 69.8 ± 11.6 | 75.3 ± 10.0 * | 78.8 ± 10.0 * | <0.001 |
Hemoglobin (g/dL) | 12.7 ± 1.9 | 13.0 ± 2.0 * | 13.8 ± 1.8 * | <0.001 |
hs-CRP (mg/dL) | 0.6 ± 0.6 | 0.7 ± 4.3 | 0.8 ± 2.4 | 0.783 |
Glucose (mg/dL) | 96.7 ± 14.5 | 105.1 ± 29.5 | 113.3 ± 37.2 * | 0.004 |
Serum creatinine (mg/dL) | 1.1 ± 0.9 | 1.1 ± 1.0 | 1.1 ± 0.6 | 0.945 |
eGFR (mL/min/1.73 m2) | 111.1 ± 38.1 | 101.7 ± 36.9 | 93.3 ± 32.1* | 0.006 |
Serum albumin (g/dL) | 4.1 ± 0.5 | 4.0 ± 0.6 | 3.9 ± 0.6 | 0.303 |
AST (IU/L) | 19.6 ± 5.1 | 22.3 ± 10.9 | 24.3 ± 10.0 * | 0.021 |
ALT (IU/L) | 12.7 ± 6.2 | 20.2 ± 28.0 | 25.9 ± 19.6 * | 0.003 |
Serum uric acid (mg/dL) | 5.3 ± 1.9 | 5.9 ± 1.9 | 6.5 ± 2.0 * | <0.001 |
Total cholesterol (mg/dL) | 169.8 ± 38.5 | 183.7 ± 48.8 | 201.0 ± 68.0 * | 0.001 |
Triglyceride (mg/dL) | 95.5 ± 49.2 | 132.8 ± 99.5 | 209.0 ± 163.3 *,† | <0.001 |
LDL-C (mg/dL) | 94.4 ± 132.8 | 104.9 ± 37.1 | 118.0 ± 46.3 * | <0.001 |
HDL-C (mg/dL) | 59.3 ± 17.0 | 54.1 ± 16.1 | 48.4 ± 16.9 * | <0.001 |
24-h proteinuria (g/day) | 0.45 ± 0.85 | 0.93 ±1.52 | 1.46 ±2.71 * | 0.007 |
Urine RBCs (grade) | 3.0 ± 1.5 | 2.8 ± 1.6 | 2.8 ± 1.6 | 0.697 |
Serum C3 (mg/dL) | 87.2 ± 17.1 | 101.1 ± 19.6 * | 117.8 ± 20.7 *,† | <0.001 |
Serum C4 (mg/dL) | 22.7 ± 5.4 | 27.4 ± 9.0 * | 31.6 ± 8.9 *,† | <0.001 |
Serum IgA (mg/dL) | 284.0 ± 109.0 | 316.1 ± 164.3 | 310.7 ± 147.6 | 0.475 |
BMI | ||||
---|---|---|---|---|
<18.5 kg/m2 | 18.5–24.9 kg/m2 | ≥25 kg/m2 | p | |
Total glomerular number | 15.9 ± 8.9 | 13.9 ± 7.9 | 12.1 ± 7.1 *,† | 0.003 |
Light microscopy | ||||
Glomerulosclerosis, Total (%) | 20.1 ± 27.8 | 24.3 ± 24.6 | 26.9 ± 25.1 * | 0.101 |
Global sclerosis (%) | 10.2 ± 20.4 | 16.7 ± 19.4* | 17.8 ± 19.9 * | 0.015 |
Segmental sclerosis (%) | 7.3 ± 9.7 | 8.3 ± 13.0 | 9.5 ± 14.5 | 0.731 |
Mesangial matrix expansion (0–4) | 1.7 ± 1.0 | 2.1 ± 0.9 | 2.2 ± 0.7 * | 0.042 |
Mesangial cell proliferation (0–4) | 1.8 ± 1.1 | 2.0 ± 0.9 | 2.1 ± 0.9 | 0.292 |
Crescents (%) | 1.6 ± 4.7 | 2.6 ± 8.0 | 2.0 ± 7.5 | 0.951 |
Interstitial fibrosis (0–4) | 1.1 ± 1.0 | 1.3 ± 1.0 | 1.4 ± 0.9 * | 0.046 |
Tubular atrophy (0–4) | 1.3 ± 1.0 | 1.2 ± 1.0 | 1.4 ± 0.9 † | 0.033 |
Arterial intimal hyalinosis (0–4) | 0.3 ± 0.6 | 0.2 ± 0.6 | 0.3 ± 0.8 | 0.213 |
Fibrous wall thickening (0–4) | 0.3 ± 0.7 | 0.5 ± 0.9 | 0.6 ± 1.0 | 0.269 |
Immunofluorescence microscopy | ||||
IgA Mesangial deposit (0–4) | 2.9 ± 1.2 | 3.3 ± 0.9 | 3.2 ± 1.0 | 0.177 |
C3 Mesangial deposit (0–4) | 2.3 ± 1.3 | 2.3 ± 1.1 | 1.8 ± 1.2 *,† | <0.001 |
C4d Mesangial deposit (0–4) | 0.1 ± 0.2 | 0.2 ± 0.1 | 0.1 ± 0.4 | 0.903 |
BMI | ||||
---|---|---|---|---|
<18.5 kg/m2 | 18.5–24.9 kg/m2 | ≥25 kg/m2 | p | |
WHO classification (n = 436) | n = 22 | n = 255 | n = 159 | |
Grade (1–6) | 2.91 ± 0.92 | 2.93 ± 0.93 | 2.98 ± 0.86 | 0.834 |
Oxford classification (n = 173) | n = 10 | n = 95 | n = 68 | |
M0 (%) | 4 (40) | 51 (53.7) | 33 (48.5) | 0.630 |
M1 (%) | 6 (60) | 44 (46.3) | 35 (51.5) | |
E0 (%) | 6 (60) | 73 (76.8) | 50 (73.5) | 0.492 |
E1 (%) | 4 (40) | 22 (23.2) | 18 (26.5) | |
S0 (%) | 3 (30.0) | 53 (55.8) | 29 (42.6) | 0.117 |
S1 (%) | 7 (70.0) | 42 (44.2) | 39 (57.4) | |
T0 (%) | 7 (70.0) | 72 (75.8) | 50 (73.5) | 0.778 |
T1 (%) | 3 (30.0) | 18 (18.9) | 16 (23.5) | |
T2 (%) | 0 (0) | 5 (5.3) | 2 (2.9) |
BMI | ||||||
---|---|---|---|---|---|---|
Univariable | Multivariable | |||||
β | t | p | β | t | p | |
Total glomerular number | −0.162 | −3.802 | <0.001 | −0.092 | −2.192 | 0.029 |
Mesangial matrix expansion | 0.086 | 2.004 | 0.046 | 0.091 | 2.205 | 0.028 |
Mesangial cell proliferation | 0.048 | 1.112 | 0.266 | 0.066 | 1.585 | 0.114 |
Segmental sclerosis | 0.040 | 0.934 | 0.351 | 0.062 | 1.428 | 0.154 |
Endocapillary proliferation | 0.128 | 2.974 | 0.003 | 0.052 | 1.236 | 0.217 |
Interstitial fibrosis | 0.087 | 2.020 | 0.044 | 0.028 | 0.547 | 0.585 |
Tubular atrophy | 0.099 | 2.286 | 0.023 | 0.036 | 0.701 | 0.484 |
IgA Mesangial Deposit | −0.025 | −0.5825 | 0.561 | 0.086 | 2.048 | 0.041 |
C3 Mesangial Deposit | −0.151 | −3.521 | <0.001 | 0.008 | 0.187 | 0.852 |
C4d Mesangial Deposit | 0.026 | 0.588 | 0.557 | 0.004 | 0.086 | 0.932 |
Crude OR | Model 1 | Model 2 | ||||
---|---|---|---|---|---|---|
OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | |
Mesangial matrix expansion | ||||||
<18.5 | 0.595 (0.269–1.318) | 0.201 | 0.586 (0.259–1.327) | 0.200 | 0.369 (0.150–0.904) | 0.029 |
18.5–24.9 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | |||
≥25 | 2.201 (1.249–3.539) | 0.005 | 2.066 (1.227–3.478) | 0.006 | 2.060 (1.120–3.788) | 0.020 |
Interstitial fibrosis | ||||||
<18.5 | 0.685 (0.319–1.471) | 0.332 | 1.084 (0.475–2.472) | 0.848 | 0.568 (0.157–2.056) | 0.389 |
18.5–24.9 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | |||
≥25 | 1.436 (1.000–2.062) | 0.05 | 1.121 (0.761–1.651) | 0.564 | 1.297 (0.759–2.216) | 0.341 |
Tubular Atrophy | ||||||
<18.5 | 0.983 (0.468–2.063) | 0.964 | 1.550 (0.282–1.550) | 0.282 | 0.861 (0.252–2.937) | 0.811 |
18.5–24.9 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | |||
≥25 | 1.679 (1.168–2.413) | 0.005 | 1.338 (0.909–1.969) | 0.140 | 1.644 (0.961–2.812) | 0.070 |
IgA mesangial deposit | ||||||
<18.5 | 0.236 (0.069–0.800) | 0.021 | 0.236 (0.069–0.800) | 0.021 | 0.208 (0.049–0.889) | 0.034 |
18.5–24.9 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | |||
≥25 | 0.508 (0.215–1.199) | 0.508 | 0.553 (0.228–1.344) | 0.191 | 0.871 (0.279–2.714) | 0.812 |
C3 mesangial deposit | ||||||
<18.5 | 0.812 (0.360–1.831) | 0.615 | 0.533 (0.321–1.800) | 0.533 | 0.516 (0.167–1.599) | 0.252 |
18.5–24.9 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | |||
≥25 | 0.506 (0.343–0.749) | <0.001 | 0.544 (0.365–0.810) | 0.003 | 0.805 (0.469–1.380) | 0.430 |
eGFR | 24-h Proteinuria | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | |||||||||
β | t | p | β | t | p | β | t | p | β | t | p | |
Age | −0.438 | −11.270 | <0.001 | −0.273 | −7.079 | <0.001 | 0.106 | 2.283 | 0.023 | - | - | - |
SBP | −0.264 | −6.315 | <0.001 | −0.101 | −0.265 | 0.008 | 0.167 | 3.629 | <0.001 | - | - | - |
DBP | −0.221 | 5.224 | <0.001 | 0.088 | 1.878 | 0.061 | - | - | - | |||
BMI | −0.175 | −4.102 | <0.001 | 0.135 | 2.921 | 0.004 | - | - | - | |||
Hemoglobin | 0.306 | 7.403 | <0.001 | −0.015 | −0.315 | 0.753 | - | - | - | |||
Glucose | −0.089 | −2.036 | 0.042 | −0.020 | −0.414 | 0.679 | - | - | - | |||
eGFR | - | - | - | −0.272 | −6.049 | <0.001 | −0.120 | −2.653 | 0.008 | |||
Albumin | 0.413 | 10.482 | <0.001 | 0.201 | 5.260 | <0.001 | −0.455 | −10.933 | <0.001 | −0.429 | −9.454 | <0.001 |
Total cholesterol | −0.59 | −1.351 | 0.177 | 0.193 | 4.206 | <0.001 | - | - | - | |||
Triglyceride | −0.125 | −2.884 | 0.004 | 0.058 | 1.233 | 0.218 | - | - | - | |||
LDL-C | −0.083 | −1.878 | 0.061 | 0.216 | 4.661 | <0.001 | - | - | - | |||
HDL-C | 0.197 | 4.500 | <0.001 | 0.087 | 2.314 | 0.021 | 0.006 | 0.122 | 0.903 | - | - | - |
Serum C3 | 0.046 | 1.035 | 0.301 | 0.159 | 3.390 | 0.001 | 0.162 | 3.851 | <0.001 | |||
Serum C4 | −0.233 | −5.389 | <0.001 | 0.170 | 3.631 | <0.001 | ||||||
Serum IgA | −0.142 | −3.166 | 0.002 | −0.017 | −0.353 | 0.724 | - | - | - | |||
24-h proteinuria | −0.272 | −6.049 | <0.001 | - | - | - | - | - | - | |||
Total glomerular number | 0.103 | 2.392 | 0.017 | 0.109 | 2.967 | 0.003 | −0.089 | −1.909 | 0.057 | - | - | - |
Mesangial matrix expansion | −0.065 | −1.495 | 0.136 | 0.058 | 1.246 | 0.213 | - | - | - | |||
Mesangial cell proliferation | −0.023 | −0.532 | 0.595 | 0.059 | 1.263 | 0.207 | - | - | - | |||
Endocapillary proliferation | −0.108 | −2.496 | 0.013 | 0.028 | 0.601 | 0.548 | - | - | - | |||
Interstitial fibrosis | −0.511 | −13.678 | <0.001 | −0.408 | −10.284 | <0.001 | 0.191 | 4.140 | <0.001 | - | - | - |
Tubular atrophy | −0.485 | −12.759 | <0.001 | - | - | - | 0.192 | 4.173 | <0.001 | - | - | - |
Mesangial deposit, IgA | 0.104 | 2.414 | 0.016 | - | - | - | 0.012 | 0.250 | 0.803 | - | - | - |
Mesangial deposit, C3 | −0.002 | −0.046 | 0.963 | - | - | - | 0.007 | 0.142 | 0.888 | - | - | - |
BMI | ||||
---|---|---|---|---|
<18.5 kg/m2 | 18.5–24.9 kg/m2 | ≥25 kg/m2 | p | |
Anti-hypertensive medications | ||||
RAAS blocker | 21 (65.6) | 223 (71.5) | 157 (81.3) | 0.029 |
CCB | 3 (9.4) | 41 (13.1) | 57 (29.5) | <0.001 |
B-blocker | 1 (3.1) | 14 (4.5) | 22 (11.4) | 0.015 |
Diuretics | ||||
Thiazide | 0 (0.0) | 1 (0.3) | 7 (3.6) | 0.033 |
Furosemide | 2 (6.2) | 23 (7.4) | 21 (10.9) | 0.523 |
Lipid lowering agents | ||||
Statin | 6 (18.8) | 74 (23.7) | 83 (43.0) | <0.001 |
Omega-3 fatty acid | 3 (9.4) | 53 (17.0) | 38 (19.7) | 0.266 |
Immunosuppressive agents | ||||
Any immunosuppression | 24 (75.0) | 210 (67.3) | 128 (66.3) | 0.248 |
Steroid | 4 (12.5) | 84 (26.9) | 63 (32.6) | 0.036 |
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Hong, Y.A.; Min, J.W.; Ha, M.A.; Koh, E.S.; Kim, H.D.; Ban, T.H.; Kim, Y.S.; Kim, Y.K.; Kim, D.; Shin, S.J.; et al. The Impact of Obesity on the Severity of Clinicopathologic Parameters in Patients with IgA Nephropathy. J. Clin. Med. 2020, 9, 2824. https://doi.org/10.3390/jcm9092824
Hong YA, Min JW, Ha MA, Koh ES, Kim HD, Ban TH, Kim YS, Kim YK, Kim D, Shin SJ, et al. The Impact of Obesity on the Severity of Clinicopathologic Parameters in Patients with IgA Nephropathy. Journal of Clinical Medicine. 2020; 9(9):2824. https://doi.org/10.3390/jcm9092824
Chicago/Turabian StyleHong, Yu Ah, Ji Won Min, Myung Ah Ha, Eun Sil Koh, Hyung Duk Kim, Tae Hyun Ban, Young Soo Kim, Yong Kyun Kim, Dongryul Kim, Seok Joon Shin, and et al. 2020. "The Impact of Obesity on the Severity of Clinicopathologic Parameters in Patients with IgA Nephropathy" Journal of Clinical Medicine 9, no. 9: 2824. https://doi.org/10.3390/jcm9092824