@article{oai:miyazaki-u.repo.nii.ac.jp:00001364.1,
 author = {小松, 弘幸 and Komatsu, Hiroyuki and 藤元, 昭一 and Fujimoto, Shouichi and Sato, Yuji and Hara, Seiichiro and Yamada, Kazuhiro and Morita, Satoshi and Eto, Tanenao},
 issue = {6},
 journal = {Journal of Nephrology},
 month = {Nov},
 note = {Background: Based on observations of the clinical course of patients with IgA nephropathy （IgAN）, D'Amico et al. proposed the concept of the `point of no return （PNR）', after which progression to end-stage renal disease （ESRD） becomes inevitable. They reported that the approximate PNR is 3.0 mg/dl serum creatinine （sCr）.
Methods: To confirm the PNR and to clarify the factors affecting the deterioration of renal function in IgAN patients, we analyzed the sequential data of those with 1.2≦ sCr <2.0 mg/dl at renal biopsy. Forty-seven patients with moderate to severe histological lesions and whose 36 month follow-up did not require renal replacement therapy, were enrolled in this study.
Results: None of the patients who once exceeded a sCr value of 2.0 mg/dl could return to below 2.0 mg/dl during the observation period. Kaplan-Meier analysis revealed that the renal outcome of patients with average values of MBP ≧102 mmHg and/or UP score ≧2.0 until 2.0 mg/dl sCr was significantly poor. Multivariate analysis using the Cox proportional hazards model, identified only MBP and UP during the course until 2.0 mg/dl sCr as independent prognostic factors for ESRD, having hazard ratios of 2.56 （per 10mmHg; 95% CI, 1.08 to 6.05） and 4.37 （per 0.5 point; 1.36 to 14.1）, respectively.
Conclusions: We confirmed PNR as a sCr level of 2.0 mg/dl （equivalent to estimated glomerular filtration rate of 30 to 35 ml/min/1.73m2） during the course of IgAN in Japan. The management of both BP and UP until sCr has reached PNR is essential to arrest the progression to ESRD in IgAN.},
 pages = {690--695},
 title = {Point of no return (PNR) in progressive IgA nephropathy: Significance of blood pressure and proteinuria management up to PNR},
 volume = {18},
 year = {2005},
 yomi = {コマツ, ヒロユキ and フジモト, シヨウイチ}
}