Early progression markers in ADPKD. A longitudinal study in patients with normal GFR

AZURMENDI, PABLO J; FRAGA, ADRIANA; VALDEZ, MARTA; ARRIZURIETA, ELVIRA; MART¨ªN, RODOLFO S

San Diego

Congreso; Annual meeting of the Am Soc Nephrology; 2011

Sociedad Americana de Nefrolog¨ªa

EARLY PROGRESSION MARKERS IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE. A LONGITUDINAL STUDY IN PATIENTS WITH NORMAL GFR. Pablo J. Azurmendi, Adriana R. Fraga, Marta G. Valdez, Elvira Arrizurieta, Rodolfo S. Martin. J Am Soc Nephrol 2011; 22: 301A. It is well known that total renal volume (VRT) is a predictor of ADPKD progression. However, parameters other than TRV are also currently explored in early stages of the disease, when glomerular filtration rate (GFR) is still preserved. We have previously reported that both urinary monocyte chemoattractant protein-1 (MCP-1) and albuminuria, assessed as urinary albumin/creatinine (UACR), are candidates for early markers of progression. High UACR (>6.8 mg/gCr) was associated with both high levels of urine MCP-1 and carotid-intima media thickness as well, as compared with normal UACR (¡Ü6.8).    To investigate whether there is an interaction among VRT, GFR and MCP-1 and a role for UACR as a predictor of disease severity, we performed a longitudinal study of 30¡À1 months in 32 young ADPKD patients (26¡À1 years old).     VRT was measured by ultrasound, urine MCP-1 by ELISA and GFR estimated by MDRD.    TRV, GFR and urine MCP-1 baseline values were 415 ¡À 52.8 ml, 108 ¡À 3 ml/min/1.73m2 and 152 ¡À 32 ng/gCr, respectively. An association among the annual change in VRT, GFR and urine MCP-1 was found, independently of their basal values, UACR, age, sex or antihypertensive treatment. The annual change in VRT and urine MCP-1 was increased in high UACR (131 ¡À 33 ml and 108 ¡À 49%), as compared with normal UACR patients (48 ¡À 41 ml and - 5 ¡À 16 %, p<0.05, respectively). The GFR annual change was not different according to UACR and remained stable in patients treated with angiotensin converting enzyme inhibitors as compared with untreated normotensive subjects (3 ¡À 5 and -5 ¡À 2 ml/min/year, p<0.01). Conclusions: Being MCP-1 and VRT markers of renal inflammatory and cystic component respectively, our results suggest an involvement of both processes in ADPKD progression, even when GFR is within normal limits. Besides this, slight increased rates of albuminuria could be also a predictor of worst prognosis.