Feature Reports:Nephrosis

The relationship between remnant cholesterol and clinicopathological characteristics in patients with IgA nephropathy

  • Shuo LI ,
  • Yunpeng ZHANG ,
  • Yan HUANG ,
  • Jing WANG ,
  • yang BAI ,
  • Shuzhong. DUAN
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  • Department of Nephrology,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei,China.

Received date: 2025-08-05

  Online published: 2025-11-13

Abstract

Objective To investigate the association between remnant cholesterol (RC) and clinicopathological parameters in patients with IgA nephropathy (IgAN), and to assess the clinical significance of RC in the progression and management of IgAN. Methods A total of 366 patients with a biopsy?proven diagnosis of IgAN were consecutively enrolled in this retrospective study. Clinical and pathological data were systematically collected, and RC was calculated. Participants were stratified into two groups according to the median RC value. Baseline characteristics were compared between these groups. The association between RC and the presence of tubular atrophy/interstitial fibrosis (T1/2 lesions) in IgAN patients was evaluated using binary logistic regression, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) curve analysis, and subgroup analyses. Results In this study, the high?RC group exhibited significantly higher levels of body weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), total cholesterol (TC), non?high?density lipoprotein cholesterol (non?HDL?C), uric acid (UA), complement 3 (C3), and 24?hour urinary protein, as well as lower levels of albumin (ALB), estimated glomerular filtration rate (eGFR), and high?density lipoprotein cholesterol (HDL?C), compared to the low?RC group. Patients with T1/2 lesions showed elevated levels of SBP, DBP, TC, non?HDL?C, UA, 24?hour urinary protein, and RC, along with reduced levels of hemoglobin (Hb), ALB, and eGFR, relative to those with T0 lesions. Multivariate logistic regression analysis indicated that increased RC and decreased eGFR were independent risk factors for the presence of T1/2 lesions in patients with IgAN (P < 0.05). RCS analysis revealed a linear association between RC and the likelihood of T1/2 lesions (non?linearity P = 0.343). The area under the receiver operating characteristic curve (AUC) for a predictive model incorporating RC, Hb, UA, and eGFR was 0.833, indicating good discriminative ability. Subgroup analyses consistently demonstrated a significant association between RC and the risk of T1/2 lesions, with no statistically significant interactions observed across subgroups (all P > 0.05). Conclusion RC can reflect the severity of both clinical and pathological manifestations in patients with IgAN, making RC monitoring a potentially valuable tool for assessing disease progression in clinical practice.

Cite this article

Shuo LI , Yunpeng ZHANG , Yan HUANG , Jing WANG , yang BAI , Shuzhong. DUAN . The relationship between remnant cholesterol and clinicopathological characteristics in patients with IgA nephropathy[J]. The Journal of Practical Medicine, 2025 , 41(21) : 3322 -3329 . DOI: 10.3969/j.issn.1006-5725.2025.21.004

References

[1] 张胜雷,田芮聪,靳晶晶,等. IgA肾病患者的淋巴细及肾脏预后的关系胞亚群与临床病理特征[J]. 实用医学杂志,2025,41(3):352-357.
[2] LIU S D, LU Z Z, FU Z K, et al. Clinicopathological Characteristics and Outcomes of Immunoglobulin A Nephropathy with Different Types of Dyslipidemia: A Retrospective Single-Center Study[J]. Kidney Blood Press Res,2023,48(1): 186-193. doi:10.1159/000529822
[3] PEI G Q, QIN A Y, DONG L Q,et al. Prognostic value of triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) in IgA nephropathy patients[J].Front Endocrinol (Lausanne),2022,13:877794. doi:10.3389/fendo.2022.877794
[4] ZHUANG H J, LIN Z L, ZENG S H,et al.Dyslipidemia may be a risk factor for progression in children with IgA nephropathy[J].Pediatr Nephrol,2022,37 (12):3147-3156. doi:10.1007/s00467-022-05480-x
[5] ANGELA P, ALBERICO L C. Remnant cholesterol: A reliable prognostic marker?[J]. Eur J Prev Cardiol,2024,31(10): 1203-1204. doi:10.1093/eurjpc/zwad107
[6] DENG J H, TANG R Y, CHEN J X,et al. Remnant cholesterol as a risk factor for all-cause and cardiovascular mortality in incident peritoneal dialysis patients[J]. Nutr Metab Cardiovasc Dis,2023,33(5):1049-1056. doi:10.1016/j.numecd.2023.02.009
[7] LI B, WANG A, WANG Y,et al. A study on the correlation between remnant cholesterol and urinary albumin to creatinine ratio in Chinese community adults: A report from the REACTION study[J]. J Diabetes,2020, 12(2):870-880. doi:10.1111/1753-0407.13076
[8] SOO Y J, MIN W K, EYUN S,et al. Remnant cholesterol is an independent risk factor for the incidence of chronic kidney disease in newly-diagnosed type 2 diabetes: A nationwide population-based study[J]. Diabetes Research and Clinical Practice,2024,210:111639. doi:10.1016/j.diabres.2024.111639
[9] ZHU W, LIU Q, LIU F,et al. High remnant cholesterol as a risk factor for developing chronic kidney disease in patients with prediabetes and type 2 diabetes: A cross-sectional study of a US population[J]. Acta Diabetol,2024,61(6):735-743. doi:10.1007/s00592-024-02249-6
[10] TRIMARCHI H, BARRATT J, CATTRAN D C, et al. Oxford classification of IgA nephropathy 2016:An update from the IgA nephropathy classification working group[J]. Kidney Int,2017,91(5):1014-1021.
[11] XIONG Y J, SHAO D M, ZHU X Y,et al. Joint Association of Remnant Cholesterol and Body Mass Index with Hypertension: A National Cohort Study in Chinese Adults[J]. J Multidiscip Healthc,2025,30(18):1813-1825.
[12] PASCHALIS K, DIMITRIOS P, MANFREDI R,et al. Association between remnant cholesterol and chronic kidney disease: Systematic review and meta-analysis[J]. Diabe tes Obes Metab,2025,27(5):2573-2583.
[13] YUAN Y G, HU X M, ZHANG S H,et al. High remnant-cholesterol levels increase the risk for end-stage renal disease: A nationwide, population-based,cohort study[J]. J Multidiscip Healthc,2025,30 (18):1813-1825.
[14] DUCASA G M, MITROFANOVA A, MALLELA S K, et al. ATP-binding cassette A1 deficiency causes cardiolipin-driven mitochondrial dysfunction in podocytes[J]. J Clin Invest,2019,129(8):3387-3400. doi:10.1172/jci125316
[15] ZHAO Y F, ZHU L, LIU L J, et al. Measures of urinary protein and albumin in the prediction of progression of IgA nephropathy[J]. Clin J Am Soc Nephrol,2016,11(6):947-955. doi:10.2215/cjn.10150915
[16] WANG S Q, DONG L Q, QIN A Y, et al. Roles of mesangial C3 and C1q deposition in the clinical manifestations and prognosis of IgAN[J]. Int Immunopharmacol,2023,120:110354. doi:10.1016/j.intimp.2023.110354
[17] HONG Y A, MIN J W, MYUNGy A H, et al. The Impact of Obesity on the Severity of Clinicopathologic Parameters in Patients with IgA Nephropathy[J]. J Clin Med,2020,9(9):2824. doi:10.3390/jcm9092824
[18] NORDESTGAAR D B G.Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease:New insights from epidemiology,genetics,and biology[J]. Circ Res,2016,118(4):547-563. doi:10.1161/circresaha.115.306249
[19] MA L, GILANI A, RUBIO-NAVARRO A, et al. Adipsin and adipocyte-derived C3aR1 regulate thermogenic fat in a sex-dependent fashion[J]. JCI Insight,2024,9(11):e178925. doi:10.1172/jci.insight.178925
[20] ZHOU W, WANG T, ZHU L J, et al. Associations of body mass index and remnant cholesterol with hyperuricemia in patients with hypertension[J]. BMC Endocr Disord,2025,25(1):73. doi:10.1186/s12902-025-01902-7
[21] LIU B M, ZHAO L Y, YANG Q Q, et al. Hyperuricemia and hypertriglyceridemia indicate tubular atrophy/interstitial fbrosis in patients with IgA nephropathy and membranous Nephropathy[J].Int Urol Nephrol, 2021,53(11): 2321-2332. doi:10.1007/s11255-021-02844-4
[22] ZHANG K, TANG L, JIANG S S,et al. Is hyperuricemia an independent prognostic factor for IgA nephropathy: A systematic review and meta-analysis of observational cohort studies[J]. Ren Fail,2022,44(1):70-80. doi:10.1080/0886022x.2021.2019589
[23] TU M Y, HU S P, LOU Z Q. A high value of fibrinogen in immunoglobulin A nephropathy patients is associated with a worse renal tubular atrophy/interstitial fibrosis score[J]. J Clin Lab Anal,2022,36 (1):e24120. doi:10.1002/jcla.24120
[24] MOHD R, MOHAMMAD K N E, ABDUL C R,et al. Long term outcome of immunoglo bulin A (IgA) nephropathy: A single center experience[J]. PloS one,2021,16 (4):249-265. doi:10.1371/journal.pone.0249592
[25] CHEN S X, CHEN J X, LI S M, et al. High-fat diet-induced renal proximal tubular inflammatory injury: Emerging risk factor of chronic kidney disease[J]. Front In Physiol,2021,12:786599. doi:10.3389/fphys.2021.786599
[26] DU X G, RUAN X Z. Lipid metabolism disorder and renal fibrosis[J]. Adv In Exp Med Biol,2019,1165:525-541. doi:10.1007/978-981-13-8871-2_26
[27] FERRO C J, MARK P B, KANBAY M,et al. Lipid management in patients with chronic kidney disease[J]. Nat Rev Nephrol,2018,14(12):727-749. doi:10.1038/s41581-018-0072-9
[28] WEN D M, TANG Y, TAN L,et al. Sex disparities in IgA nephropathy: A retrospective study in Chinese patients[J]. Int Urol Nephrol,2021,53(2):315-323. doi:10.1007/s11255-020-02631-7
[29] CAO R, SU W, SHENG J, et al. Estrogen receptor β attenuates renal fibrosis by suppressing the transcriptional activity of Smad3[J]. Biochim Biophys Acta Mol Basis Dis,2023,1869(6):166755. doi:10.1016/j.bbadis.2023.166755
[30] NASHAT A. Men's health disparities: Causes and interventions[J]. Nurs Forum,2022,57 (5):785-792. doi:10.1111/nuf.12764
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