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학술저널
저자정보
박혜인 (한림대학교) Kim Juhee (Department of Internal Medicine Hallym University College of Medicine Seoul Korea.) 조아진 (한림대학교) Kim Do Hyoung (Department of Internal Medicine Hallym University College of Medicine Seoul Korea.Hallym University) 이영기 (한림대학교) Ryu Hyunjin (Department of Internal Medicine Seoul National University Hospital Seoul Korea.) 김현숙 (한림대학교) Oh Kook-Hwan (Department of Internal Medicine Seoul National University Hospital Seoul Korea.) 오윤규 (서울대학교) Hwang Young-Hwan (Truewords Dialysis Clinic Incheon Korea.) Lee Kyu-Beck (Department of Internal Medicine Kangbuk Samsung Hospital Seoul Korea.) Kim Soo Wan (Department of Internal Medicine Chonnam National University Medical School Gwangju Korea.) Kim Yeong Hoon (Department of Internal Medicine Busan Paik Hospital) Lee Joongyub (Preventive and Management Center Inha University Hospital) 안규리 (서울대학교) KNOW-CKD Investigators Group (KNOW-CKD Investigators Group)
저널정보
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.35 No.22
발행연도
2020.1
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1 - 11 (11page)

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Background: Intrarenal renin-angiotensin system (RAS) is known to play the major role in the development of hypertension and renal progression in autosomal dominant polycystic kidney disease (ADPKD). Urinary angiotensinogen to creatinine ratio (AGT/Cr) was suggested as a novel biomarker to reflect intrarenal RAS activity. This study was performed to evaluate urinary AGT/Cr as a predictive biomarker for renal function decline in addition to imaging classification in a prospective ADPKD cohort. Methods: From 2011 to 2016, a total of 364 ADPKD patients were enrolled in the prospective cohort called the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Among them, a total of 207 subjects in chronic kidney disease stage 1–4 with baseline urinary AGT and total kidney volume and subsequent renal function follow-up data over more than 1 year were included in the analysis. Patients were defined as slow progressors (SP) if they are classified as 1A or 1B by imaging classification whereas rapid progressors (RP) if they are classified as 1C–1E. Patients were divided according to AGT/Cr quartiles and annual estimated glomerular filtration rate (eGFR) slope was compared among highest quartile (hAGT group) and the rest of quartiles (lAGT group). Patients were divided into 4 groups to evaluate the predictive value of urinary AGT/Cr in addition to imaging classification: SP/lAGT, SP/hAGT, RP/lAGT, and RP/hAGT. The Cox regression model was used to evaluate the hazard ratio (HR) between groups. Results: The mean age was 45.9 years and 88.9% had hypertension. Baseline eGFR was 79.0 ± 28.4 mL/min/1.73 m2 and median height-adjusted total kidney volume was 788.2 (471.2;1,205.2) mL/m. The patients in the hAGT group showed lower eGFR (72.4 ± 24.8 vs. 81.1 ± 29.2 mL/min/1.73 m2 , P = 0.039), lower plasma hemoglobin (13.0 ± 1.4 vs. 13.7 ± 1.6 g/dL, P = 0.007), higher urinary protein to creatinine ratio (0.14 [0.09, 0.38] vs. 0.07 [0.04, 0.12] g/g, P = 0.007) compared to the lAGT group. The hAGT group was an independent risk factor for faster eGFR decline after adjusting for gender, RP, baseline eGFR, and other known risk factors. During median follow-up duration of 4.6 years, a total of 29 renal events (14.0%) occurred. The SP/hAGT group showed significantly higher risk of developing renal outcome compared to SP/lAGT group (HR, 13.4; 95% confidence interval, 1.282–139.324; P = 0.03). Conclusion: Urinary AGT/Cr can be a useful predictive marker in the patients with relatively small ADPKD. Various biomarkers should be considered to define RP when implementing novel treatment in the patients with ADPKD.
#Angiotensinogen #Biomarkers #Glomerular Filtration Rate #Autosomal Dominant Polycystic Kidney

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참고문헌 (23)

참고문헌 신청
Davies F / 1991 / Polycystic kidney disease re-evaluated : a population-based study / Q J Med 79(290):477~485 google schola Higashihara E / 1998 / Prevalence and renal prognosis of diagnosed autosomal dominant polycystic kidney disease in Japan / Nephron 80(4):421~427 google schola Neumann HP / 2013 / Epidemiology of autosomaldominant polycystic kidney disease : an in-depth clinical study for south-western Germany / Nephrol Dial Transplant 28(6):1472~1487 google schola Chebib FT / 2018 / A practical guide for treatment of rapidly progressive ADPKD with Tolvaptan / J Am Soc Nephrol 29(10):2458~2470 google schola Irazabal MV / 2015 / Imaging classification of autosomal dominant polycystic kidney disease : a simple model for selecting patients for clinical trials / J Am Soc Nephrol 26(1):160~172 google schola

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