Frontiers in nephrology · 2026
The lactate dehydrogenase-to-albumin ratio is independently associated with moderate-to-severe tubulointerstitial fibrosis in patients with IgA nephropathy.
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Zheng Luli, Yang Guokai
Аннотация
BACKGROUND: Tubulointerstitial fibrosis accelerates the progression of immunoglobulin A nephropathy (IgAN) to end-stage renal disease (ESRD). While renal biopsy is the standard for evaluation, non-invasive biomarkers remain scarce. This study investigated the independent association and diagnostic value of the lactate dehydrogenase-to-albumin ratio (LAR) for moderate-to-severe tubulointerstitial fibrosis (Oxford T1+T2) in IgAN patients.
METHODS: We retrospectively analyzed 398 patients with biopsy-proven primary IgAN, categorized into no/mild fibrosis (T0, n=273) and moderate-to-severe fibrosis (T1+T2, n=125) groups. Clinical, laboratory, and pathological data were collected to calculate LAR. Missing data were handled using multiple imputation by chained equations (MICE). Statistical evaluations included logistic regression, ROC curves, restricted cubic splines (RCS), and subgroup analyses.
RESULTS: The T1+T2 group exhibited significantly higher median LAR levels (5.10 vs. 4.13, P < 0.001). Following adjustment for confounders, LAR remained independently associated with fibrosis (OR = 1.425, 95% CI: 1.122-1.809, P = 0.004). The AUC was 0.717, with an optimal cut-off of 4.91 (sensitivity 56.8%, specificity 78.0%). RCS analysis indicated a linear relationship (P for non-linearity = 0.2350). Subgroup analyses showed consistent positive associations (OR > 1.2), reaching statistical significance in males, patients aged ≥40 years, and those with eGFR ≥60 mL/min/1.73 m². Sensitivity analyses confirmed robustness. Patients with LAR > 4.91 demonstrated worse renal function, heavier proteinuria, and higher fibrosis incidence (54.2% vs. 20.2%, P < 0.001).
CONCLUSION: LAR is independently associated with moderate-to-severe tubulointerstitial fibrosis and demonstrates moderate diagnostic efficacy. As a cost-effective indicator, LAR may serve as a non-invasive auxiliary tool for clinical screening and risk stratification in IgAN, but it cannot replace renal biopsy as the diagnostic gold standard.
METHODS: We retrospectively analyzed 398 patients with biopsy-proven primary IgAN, categorized into no/mild fibrosis (T0, n=273) and moderate-to-severe fibrosis (T1+T2, n=125) groups. Clinical, laboratory, and pathological data were collected to calculate LAR. Missing data were handled using multiple imputation by chained equations (MICE). Statistical evaluations included logistic regression, ROC curves, restricted cubic splines (RCS), and subgroup analyses.
RESULTS: The T1+T2 group exhibited significantly higher median LAR levels (5.10 vs. 4.13, P < 0.001). Following adjustment for confounders, LAR remained independently associated with fibrosis (OR = 1.425, 95% CI: 1.122-1.809, P = 0.004). The AUC was 0.717, with an optimal cut-off of 4.91 (sensitivity 56.8%, specificity 78.0%). RCS analysis indicated a linear relationship (P for non-linearity = 0.2350). Subgroup analyses showed consistent positive associations (OR > 1.2), reaching statistical significance in males, patients aged ≥40 years, and those with eGFR ≥60 mL/min/1.73 m². Sensitivity analyses confirmed robustness. Patients with LAR > 4.91 demonstrated worse renal function, heavier proteinuria, and higher fibrosis incidence (54.2% vs. 20.2%, P < 0.001).
CONCLUSION: LAR is independently associated with moderate-to-severe tubulointerstitial fibrosis and demonstrates moderate diagnostic efficacy. As a cost-effective indicator, LAR may serve as a non-invasive auxiliary tool for clinical screening and risk stratification in IgAN, but it cannot replace renal biopsy as the diagnostic gold standard.