A tricontinental view of IgA nephropathy

Geddes, Colin C.; Rauta, Virpi; Grönhagen‐Riska, Carola; Bartosik, Lukasz P.; Jardine, Alan G.; Ibels, L. S.; Pei, York; Cattran, Daniel C.

doi:10.1093/ndt/gfg207

Cited by 170 publications

(134 citation statements)

References 19 publications

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“…Furthermore, arterial hypertension was found to be associated with progression of IgAN in several studies (4,5,7); however, in some studies from Japan, including this study, it was not found to be a predictor of progression (2,17,18). These differences may be due in part to the differences in the biopsy policies and to the stage of the diseases (19). Nevertheless, the most important finding of this study is that the prognostic value of GD, as well as the presence of the cellular/fibrocellular crescent, exceeded those of proteinuria and BP.…”

Section: Discussioncontrasting

confidence: 57%

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

Tsuboi¹,

Kawamura²,

Koike³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: An early histopathologic predictor of the renal prognosis, before the occurrence of advanced glomerular sclerosis/interstitial fibrosis and/or apparent renal dysfunction, remains to be established in IgA nephropathy (IgAN). This study aimed to determine whether the glomerular density (GD; nonsclerotic glomerular number per renal cortical area) of biopsy specimens obtained at an early stage of IgAN could predict the long-term renal outcome.Design, setting, participants, & measurements: The predictive value of the factors at biopsy, including the GD, on the renal outcome was retrospectively analyzed for 98 patients who had IgAN with an estimated GFR of >60 ml/min per 1.73 m 2 at biopsy (87 ml/min per 1.73 m 2 on average). Results: The individual value of GD in biopsy ranged from 1.2 to 8.1/mm 2 (i.e., approximately a seven-fold variation), and the GD showed a close inverse correlation with mean glomerular volume. Among the various clinicopathologic factors involved, both a cellular/fibrocellular crescent and the GD were found to be significant predictors of progression in multivariate analyses. A low GD in the biopsy specimens was frequently associated with a steeper slope of the renal function and a synergistically enhanced risk for progression with the presence of cellular/fibrocellular crescent. The renal function, proteinuria, degrees of glomerulosclerosis, and interstitial fibrosis at biopsy were not independent predictors of the prognosis in these patients.Conclusions: A strong predictive relationship of low GD with progression observed in this study suggests that GD may serve as an early histopathologic marker of long-term renal prognosis in IgAN.

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Section: Discussioncontrasting

confidence: 57%

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

Tsuboi¹,

Kawamura²,

Koike³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Given the very slow development of IgAN, a longer period of observation is required to validate our findings. Fifth, our results may not be extrapolated to other ethnic populations because a prior study suggested a geographical variability in long-term outcomes of IgAN (30). Finally, there were many covariates in some multivariate models.…”

Section: Discussionmentioning

confidence: 87%

Clinical Features and Outcomes of IgA Nephropathy with Nephrotic Syndrome

Kim¹,

Kim²,

Lee

et al. 2012

Clinical Journal of the American Society of Nephrology

100

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Summary Background and objectives Nephrotic syndrome (NS) is a rare manifestation of IgA nephropathy (IgAN). Clinical characteristics and long-term outcomes of this condition have not yet been explored. Design, setting, participants, & measurements A multicenter observational study was conducted between January 2000 and September 2010 in 1076 patients with biopsy-proven IgAN from four medical centers in Korea. The primary outcome was a doubling of the baseline serum creatinine concentration. Results Of the 1076 patients, 100 (10.2%) presented with NS; complete remission (CR), partial remission (PR), and no response (NR) occurred in 48 (48%), 32 (32%), and 20 (20%) patients, respectively. During the median follow-up of 45.2 months, 24 patients (24%) in the NS group reached the primary endpoint compared with 63 (7.1%) in the non-NS group (P<0.001). The risk of reaching the primary endpoint was significantly higher in the PR (P=0.04) and NR groups (P<0.001) than in the CR group. Among patients with NS, 24 (24%) underwent spontaneous remission (SR). SR occurred more frequently in female patients and in patients with serum creatinine levels ≤1.2 mg/dl and a >50% decrease in proteinuria within 3 months after NS onset. None of the patients with SR reached the primary endpoint and they had fewer relapses during follow-up. Conclusions This study demonstrated that the prognosis of NS in IgAN was not favorable unless PR or CR was achieved. In addition, SR was more common than expected, particularly in patients with preserved kidney function and spontaneous decrease in proteinuria shortly after NS onset.

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“…6,9, They reported predictor risk factors and somehow different renal survival based on whether screening programs were practiced in their countries. 28,33,[35][36][37][38] However, variability in disease severity should be considered as well. 35 It is important to understand which patients are at risk for progression Table 3.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Therapy Assessment of IgA Nephropathy: Report from a Single Unit in Iran

et al. 2011

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Background: Immunoglobulin A (IgA) nephropathy is the most common cause of primary glomerulonephritis with slow progression to end-stage renal disease (ESRD) in up to 40% of patients. Methods: A retrospective cohort study of patients with biopsy-proven IgA nephropathy was performed in our center from 1998 to 2009. We tried to determine the clinical and pathological factors which affect patients progressing to ESRD. We also compared the impact of renin-angiotensin system (RAS) blockers therapy alone or in combination with prednisone on baseline proteinuria and glomerular filtration rate (GFR) after 6 months of treatment in patients with proteinuria>1 g/d and GFR>30 mL/min. Results: There were 70 IgA nephropathy patients of whom 46 were men. The average age of patients at biopsy was 39 ± 12.1 years. During the median 23.5 (6-130) months of follow-up, 10 patients progressed to ESRD and no patient died. Five-year renal survival following biopsy was 88%. By multivariate analysis, age more than 50 years (p = 0.003) and baseline serum creatinine level (p = 0.012) were independent predictors of progressing to ESRD and poor prognosis. Although there was no significant difference in proteinuria reduction after 6 months of treatment, kidney function was less preserved in RAS inhibitors therapy alone than in the combination treatment with prednisone. Conclusion: We showed that late diagnosis of patients with IgA nephropathy might be associated with poor outcome. Our results also suggest that addition of prednisone to RAS blockers may lead to better preservation of kidney function.

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A tricontinental view of IgA nephropathy

Cited by 170 publications

References 19 publications

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

Clinical Features and Outcomes of IgA Nephropathy with Nephrotic Syndrome

Prognostic Factors and Therapy Assessment of IgA Nephropathy: Report from a Single Unit in Iran

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