The lactate dehydrogenase-to-albumin ratio is independently associated with moderate-to-severe tubulointerstitial fibrosis in patients with IgA nephropathy.
- 1Department of Nephrology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China.
Abstract
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.
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BibTeX
@article{zheng2026lactate,
title = {{The lactate dehydrogenase-to-albumin ratio is independently associated with moderate-to-severe tubulointerstitial fibrosis in patients with IgA nephropathy.}},
author = {Luli Zheng and Guokai Yang},
journal = {Frontiers in nephrology},
year = {2026},
month = sep,
doi = {10.3389/fneph.2026.1931478},
url = {https://europepmc.org/article/MED/42835361},
note = {CC BY},
}
RIS
TY - JOUR
TI - The lactate dehydrogenase-to-albumin ratio is independently associated with moderate-to-severe tubulointerstitial fibrosis in patients with IgA nephropathy.
AU - Luli Zheng
AU - Guokai Yang
PY - 2026
DA - 2026/09/21
JO - Frontiers in nephrology
DO - 10.3389/fneph.2026.1931478
UR - https://europepmc.org/article/MED/42835361
AB - 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.
SN - 2813-0626
ER -