J Korean Med Sci.  2009 Jan;24(Suppl 1):S22-S29. 10.3346/jkms.2009.24.S1.S22.

The Mildly Elevated Serum Bilirubin Level is Negatively Associated with the Incidence of End Stage Renal Disease in Patients with IgA Nephropathy

• Chin HJ
• Cho HJ
• Lee TW
• Na KY
• Oh KH
• Joo KW
• Yoon HJ
• Kim YS
• Ahn C
• Han JS
• Kim S
• Jeon ES
• Jin DC
• Kim YL
• Park SH
• Kim CD
• Song YR
• Kim SG
• Kim YG
• Lee JE
• Oh YK
• Lim CS
• Lee SK
• Chae DW
• Cho WY
• Kim HK
• Jo SK
• The Progressive REnal disease and Medical Informatics and gEnomics Research (PREMIER) members

• KMID: 1778136
• DOI: http://doi.org/10.3346/jkms.2009.24.S1.S22

Abstract

Oxidative stress plays various roles in the development and progression of IgA nephropathy, while bilirubin is known as a potent antioxidant. We therefore hypothesized that serum bilirubin would be associated with renal prognosis in IgA nephropathy. The study subjects comprised 1,458 adult patients with primary IgA nephropathy in Korea. We grouped patients according to the following quartile levels of bilirubin: <0.4 mg/dL (Q1), 0.4-0.5 mg/dL (Q2), 0.6-0.7 mg/dL (Q3), and >0.8 mg/dL (Q4). The outcome data were obtained from the Korean Registry of end-stage renal disease (ESRD). Eighty patients (5.5%) contracted ESRD during a mean follow-up period of 44.9 months. The ESRD incidences were 10.7% in Q1, 8.2% in Q2, 2.8% in Q3, and 2.8% in Q4 (p<0.001). The relative risk of ESRD compared to that in Q1 was 0.307 (95% confidence interval [CI], 0.126-0.751) in Q3 and 0.315 (95% CI, 0.130-0.765) in Q4. The differences of ESRD incidence were greater in subgroups of males and of patients aged 35 yr or more, with serum albumin 4.0 g/dL or more, with normotension, with eGFR 60 mL/min/1.73 m2 or more, and with proteinuria less then 3+ by dipstick test. In conclusion, higher bilirubin level was negatively associated with ESRD incidence in IgA nephropathy.

Keyword

Bilirubin; Glomerulonephritis, IGA; Kidney Failure, Chronic

MeSH Terms

Adult
Bilirubin/*blood
Disease Progression
Female
Glomerular Filtration Rate
Glomerulonephritis, IGA/*blood/complications
Humans
Hypertension/complications
Incidence
Kidney Failure, Chronic/*blood/complications
Male
Middle Aged
Risk
Risk Factors
Treatment Outcome

Figure

• 

  Fig. 1 The probability of renal survival according to serum bilirubin level at renal biopsy. Q1, First quartile group; Q2, Second quartile group; Q3, Third quartile group; Q4, Forth quartile group.

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