@article{oai:miyazaki-u.repo.nii.ac.jp:00001364,
 author = {Komatsu, Hiroyuki and 小松, 弘幸 and Fujimoto, Shouichi and 藤元, 昭一 and Sato, Yuji and 佐藤, 祐二 and Hara, Seiichiro and 原, 誠一郎 and Yamada, Kazuhiro and 山田, 和弘 and Morita, Satoshi and Eto, Tanenao and 江藤, 胤尚},
 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 and サトウ, ユウジ and ハラ, セイイチロウ and ヤマダ, カズヒロ and エトウ, タネナオ}
}