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Vol. 109, No. 3, 2008
Issue release date: August 2008

Validation of the Toronto Formula to Predict Progression in IgA Nephropathy

Mackinnon B. · Fraser E.P. · Cattran D.C. · Fox J.G. · Geddes C.C.
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Abstract

Background/Aim: Predicting outcome in IgA nephropathy (IgAN) is difficult. The Toronto formula uses average mean arterial blood pressure and proteinuria during the first 2 years of follow-up (MAP0–2, UP0–2) to predict the subsequent slope of estimated creatinine clearance (eCrCl). We aimed to validate the Toronto formula in a Scottish cohort and test the hypothesis that adding the slope eCrCl over the first 2 years of follow-up (eCrCl0–2) would improve the predictive utility of a similar multivariate model. Methods: Adultsfrom our centre with biopsy-proven IgAN (n = 169) and at least 2 years of follow-up (median 129.4 months) were included. Clinical data were used to calculate MAP0–2,UP0–2,slope eCrCl0–2 and predicted slope eCrCl (using the Toronto formula). Results: There was a significant correlation between predicted slope eCrCl using the Toronto formula and actual slope eCrCl (R2 = 0.21; p < 0.001). The formula predicted the actual rate of progression to within 4 ml/min/year in 75% of subjects, predicting patients with the most rapid deterioration with the greatest accuracy. The multivariate linear regression model created in our cohort using the same independent variables as the Toronto formula to predict the overall slope eCrCl had an R2 of 0.22 (p < 0.001) and adding the slope CrCl0–2 only increased this to 0.25. Conclusions: The Toronto formula is valid in a European population and useful for identifying patients at high risk of future deterioration in renal function. Adding slope eCrCl0–2 to a predictive model containing MAP0–2, andUP0–2 does not appear to improve prediction of the overall slope of eCrCl.



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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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