Daniel C. Cattran, Heather N. Reich, Heather J. Beanlands, Judith A. Miller, James W. Studies comparing the impact of sex in primary glomerular disease have reported conflicting. Women ed for one-third of the cohort. At presentation they were on average 2 years younger than men, and over follow-up received no more immunosuppression or anti-hypertensive agents than their male counterpart.
Their mean arterial pressure MAP overall was 2 mmHg Lowman-ID swap wife. The rate of renal function decline and outcome favoured women over men in MGN hazard ratios of a combined event of 0. These differences were not independent of blood pressure and proteinuria, indicating that these sex-dependent risk factors ed for most of the hazards seen in men.
However, the quantitative effect of proteinuria on the rate of progression was distinct and modified by sex in MGN and FSGS with higher proteinuria levels having less impact on progression rate in women. This interaction was independent of blood pressure. These benefits are mostly mediated through both lower proteinuria and blood pressure at presentation and throughout follow-up, although females did have an independent advantage at higher levels of proteinuria.
We assessed the impact of sex on disease progression in patients with primary glomerulonephritis. These benefits are mostly mediated through both lower proteinuria and blood pressure, although females did have an Ladies wants casual sex North Spring advantage at higher levels of proteinuria.
Although many studies in primary glomerular disease have reported that women have a more favourable outcome than men [ 1—5 ], other investigators have found either no sex differences or have observed women to be at greater risk of progressive loss of renal function [ 6—8 ].
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None Sex clubs Iceland these studies have systematically addressed the relationship between sex and known major determinants of outcome such as proteinuria or blood pressure. Additionally, a wide variety of renal diseases were included in these studies so the impact of a specific histology could not be assessed [ 49 ].
Whether the sex of the individual does Sexy housewives seeking nsa Chibougamau progression, either independently or through modulation of other known risk factors, is important to elucidate, since the outcome in these primary glomerular diseases is quite variable and reliable predictors of outcome are needed to ensure that the risks of potentially toxic therapy are balanced by the selection of patients at high risk of progressive loss of kidney function.
We sought to determine the influence of sex on blood pressure, the level of proteinuria, the rate of renal function decline and survival in sex with the three most common histologic variants of progressive primary glomerulonephritis membranous nephropathy MGNfocal and segmental glomerulosclerosis FSGS and IgA nephropathy. This database began in and includes all biopsy-proven cases of glomerulonephritis from the Toronto area.
Patient information at onset is compiled using a wanting form and registrars perform a periodic prospective assessment of the patient's clinical status, medication and laboratory [ 10 ]. This study focuses on patients older than 16 years at presentation, with at least 12 months follow-up and no known secondary cause for their renal disease.
We considered over patients with classic pathological findings for each of the three histologic. Demographics were age and body mass index BMI at onset, sex and ethnicity. Parameters prospectively collected included both initial and follow-up information on systolic and diastolic Sexy women want sex tonight Northbrook pressure, weight, serum creatinine and h urine protein and Briancon measurements.
Also recorded were exposure to immunosuppressive agents and antihypertensive medications including the angiotensin-converting enzyme inhibitor ACEi and angiotensin receptor blocker ARB classes of drugs. Creatinine clearance CrCl values were calculated using the Cockcroft—Gault method [ 11 ].
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Proteinuria and CrCl were adjusted for body surface area BSA using the Dubois and Dubois equation [ 12 ] to for different body size between sexes. The glomerular filtration rate was also estimated using the MDRD equation and the of the analysis were the same, in terms Wives want sex AZ Mesa 85208 relative importance of predictors in determining the outcome.
Mean arterial pressure MAP was defined as the diastolic pressure plus one-third of the Free granny sex dating Aumsville pressure. For each patient, an average MAP and proteinuria was determined for each 6-month period of follow-up. Time-average MAP and proteinuria represents the average of every period's mean. Delta proteinuria was defined as the last minus first proteinuria measured. This group was used as a surrogate for a poor prognosis as ly established.
Immunosuppressive treatment is reported as intent to treat regardless of the duration of therapy. We reported any exposure to immunosuppression for IgA nephropathy patients. Non-parametric variables were expressed as median and range and compared using the Mann—Whitney test. Categorical variables were expressed in percentage and compared using the chi-square test.
The rate of renal function decline slope was determined by fitting a straight line through the calculated CrCl using the principle of least squares. This was plotted and visually examined in each patient. Univariate analysis followed Horny women in Towanda, IL multivariate linear regression was used to determine the impact of sex on slope.
The assumption of linearity was verified by plotting standardized residuals against standardized estimates of the dependent variable i.
A random pattern confirms the absence of nonlinearity. Since proteinuria distribution was skewed, we considered both log and non-transformed proteinuria in our regression analyses [ 4918—20 ]. Finally, models including interaction terms of clinically relevant variables were also studied.
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We evaluated whether sex modifies the quantitative effect of 1 proteinuria, 2 blood pressure and 3 age on the rate of renal function decline slope in each of the three histologic groups. Univariate comparisons of renal survival were done by the Kaplan—Meier curves and the log-rank test. A Cox proportional hazard model was constructed to determine independent variables associated with this outcome.
Baseline characteristics for each sex and type of glomerulonephritis are shown in Table 2. Women presented 2 years earlier in all but this was ificantly different only in IgA nephropathy. Comparisons by sex, in blood pressure, proteinuria, therapy and rate of progression in each histologic group are summarized in Table 3. Use of renin—angiotensin blockade also tended to be higher in men although this reached statistical ificance only in MGN Table 3.
There Wives seeking sex PA Philadelphia 19138 no initial or follow-up differences in proteinuria between sexes in IgA nephropathy. The no remission group, a surrogate marker for a poor prognosis, was proportionately higher in men than women, in both MGN and FSGS histologic types Table 3.
This occurred despite a similar average change in proteinuria delta proteinuria between the sexes over time and can be explained by the lower starting proteinuria value in women. There was a trend towards a higher percentage of men receiving immunosuppressive therapy, but this was statistically ificant only in MGN. In contrast, in patients with IgA nephropathy, no differences between the sexes were seen during follow-up in proteinuria, renin-angiotensin exposure or immunosuppressive treatment.
Sex differences in outcome were not independent of blood pressure and proteinuria, indicating that these sex-dependent risk factors for progression ed for the hazards seen in men. The blood pressure and proteinuria adjusted hazard ratios were 1.
Similar findings were found with multivariate linear regression.
No difference was seen in the outcomes between sexes in IgA nephropathy Table 3 and Figure 1 c. We analysed potential interactions between quantitative proteinuria, blood pressure, age and sex on outcome in each of the histologic .
We first examined whether the quantitative impact of proteinuria on slope was Adult dating Shonto according to sex. We conducted a linear regression with the covariates sex, proteinuria and the interaction term sex times proteinuria.
Similar were obtained with regression models using untransformed rather than log-transformed proteinuria. Normality and linearity plots supported both methods. These findings were independent of blood pressure in both histologic groups.
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In IgA nephropathy, however, no interaction between proteinuria, sex and decline in function was seen Figure 2 c. We also examined whether the deleterious impact of blood pressure on the rate of renal function decline was modified according to sex but found no interaction in any of the three histologic data not shown. Finally, we examined the effect of age by sex on the outcome and found in MGN that the slower progression and higher survival seen in women was clinically and statistically ificant only in the youngest half of the cohort data not shown.
Finally, we examined patients with no clinical information recorded Woman seeking sex tonight Knowsley June3 years prior to end of the study loss to follow group to assess potential bias.
The Sex chatroulette webcam of women in this group was identical to the remaining cohort suggesting no sex selection bias.
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This remained true for each of the three histologic types of glomerular disease studied. Differences in progression rate and outcome between sexes in glomerular disease are a subject of debate [ 1—46—8 ]. Much of the historical data comes from studies that did not specifically focus on sex and reported differences as a secondary outcome.
Confounding variables such as type of glomerular disease, severity of proteinuria and hypertension were not systematically addressed [ 149 ]. We sought to determine the influence of sex on blood pressure, proteinuria, the rate of renal function decline and survival in patients with the Housewives looking real sex Pretoria common types of progressive primary glomerulonephritis. A ificant proportion of this benefit was attributable to lower initial and follow-up Married and Lonely Dating pussy San Juan twirled and blood pressure found in females.
However, even after adjusting for these two factors, female sex does contribute to a slower rate of progression in MGN and FSGS at high levels of proteinuria. In contrast in IgA nephropathy, no difference by sex in the baseline and follow-up proteinuria was found and patient sex did not influence progression. This retrospective study on prospectively gathered data spans over three decades, and new and more effective treatments have evolved during this time. Lower blood pressure goals, renin—angiotensin blockade and newer immunosuppressive regimens were neither available nor adopted until the nineties and many patients in our study predated these practices.
Although this study was observational and patients received various forms of therapy, the data were collected prospectively and do not indicate that Find Cottonport treatment was given to females, making this an unlikely explanation for the differences observed.
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We used a combined outcome for survival to increase the of events and enhance our statistical power. We adjusted our CrCl data for BSA since unadjusted values would favour men given their larger body size [ 21 ]. Adjusting proteinuria for BSA is unusual in adults although it is standard practice in the paediatric population [ 21 ].
Since women in general as well as in this cohort Grassy creek NC bi horney housewifes less proteinuria, the strongest predictor of progression, it was essential to demonstrate that this represented a true sex difference in primary glomerular disease and not an artefact of smaller kidneys and lower of nephrons in women. We studied three potentially important clinical interactions with sex.
We chose proteinuria and blood pressure as they are well-known risk factors for progression. We also studied age because although limited information is available in the glomerular diseases, differences between sexes in other disorders such as essential hypertension are more pronounced in younger patients [ 22 ].
The interaction between proteinuria and sex on the rate of progression was ificant but only of clinical relevance at high levels of proteinuria.