Characteristics and risk factors of intrarenal arterial lesions in patients with IgA nephropathy

Wu, Jie; Chen, Xiangmei; Xie, Yan; Yamanaka, Nobuaki; Shu, Shi; Wu, Di; Liu, Shuwen; Cai, Guangyan

doi:10.1093/ndt/gfh716

Cited by 68 publications

(60 citation statements)

References 11 publications

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“…It thus appears clear that TMA can precede the development of glomerulosclerosis and interstitial fibrosis rather than being a consequence of it, a sequence that has been suggested by others for vascular lesions in general in IgAN. 5 Thus, neither hypertension nor advanced parenchymal lesions are necessary prerequisites to the development of TMA.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] In immunoglobulin A nephropathy (IgAN), the most common form of primary glomerular disease worldwide, 4 it has long been recognized that intrarenal arterial and arteriolar lesions, such as arteriolar wall thickening and hyalin changes, may be a prominent feature. 5,6 Further, TMA has been described in IgAN in a recent study 7 and attributed by the authors to severe or malignant hypertension. However, a large-scale clinicopathologic analysis focused on TMA in IgAN has not been performed.…”

mentioning

confidence: 94%

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A Clinicopathologic Study of Thrombotic Microangiopathy in IgA Nephropathy

Karoui

Hill²,

Karras³

et al. 2012

Journal of the American Society of Nephrology

122

105

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Thrombotic microangiopathy (TMA) occurs in IgA nephropathy, but its clinical significance is not well described. We retrospectively examined a series of 128 patients diagnosed with IgA nephropathy between 2002 and 2008 who had a mean follow-up of 44627 months. In our series, 53% presented with lesions of TMA, acute or organized, in arteries and/or arterioles. Among patients with TMA, 4% were normotensive, 25% had controlled hypertension, and 71% had uncontrolled hypertension. Of those with uncontrolled hypertension, 26% had malignant hypertension. Histologically, the group with TMA had a significantly greater percentage of sclerotic glomeruli and worse tubulointerstitial fibrosis than those of the group without TMA. However, a significant minority of patients had near-normal histology, with minimal tubular atrophy (20%) and/or ,20% interstitial fibrosis (24%). TMA rarely occurred in the absence of significant proteinuria. During follow-up, a doubling of serum creatinine or ESRD occurred in all patients with laboratory evidence of TMA, in 42% of those with morphologic evidence but no laboratory evidence of TMA, and in 11% of those without TMA. In summary, lesions of TMA are frequent in IgA nephropathy and may occur in normotensive patients with near-normal renal histology. Although the pathophysiologic mechanisms involved remain undetermined, the current study rules out severe hypertension or advanced renal disease as sole causes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 94%

A Clinicopathologic Study of Thrombotic Microangiopathy in IgA Nephropathy

Karoui

Hill²,

Karras³

et al. 2012

Journal of the American Society of Nephrology

122

105

View full text Add to dashboard Cite

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“…8 Among these pathological changes, renal arterio-arteriolosclerosis is important, because it is known to be related to renal function and prognosis. [9][10][11][12] However, whether clinical factors other than hypertension have an impact on renal arterioarteriolosclerosis remains to be elucidated. Therefore, we noted glucose metabolism/insulin resistance as a cause of renal arterioarteriolosclerosis in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] Hypertension is known to have an important function in the pathogenesis of renal arterio-arteriolosclerosis. [12][13][14] In clinical practice, however, the evidence of renal arterio-arteriolosclerosis is sometimes found even in renal biopsy specimens of patients without hypertension.…”

Section: Introductionmentioning

confidence: 99%

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Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

et al. 2010

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Hypertension has an important function in the formation of renal arterio-arteriolosclerosis. However, renal arterioarteriolosclerosis is sometimes found in biopsy specimens of normotensive patients, which indicates unknown factors may contribute to renal arterio-arteriolosclerosis. In this study, we aimed to evaluate the effects of glucose metabolism/insulin resistance on renal arterio-arteriolosclerosis. Forty-eight patients with biopsy-proven non-diabetic chronic glomerular disease were included. Renal arterio-arteriolosclerosis was evaluated as the percentage of vessels showing hyaline changes or wall thickening. We correlated renal arterio-arteriolosclerosis with clinical parameters including indices obtained by 75 g oral glucose tolerance test. Of the 48 patients, 30 had hypertension. The results of univariate analysis showed significant association of renal arterio-arteriolosclerosis with hypertension, increased serum creatinine (S-Cr), hypertriglyceridemia, increased 2-h plasma glucose (PG) and increased 2-h plasma insulin (PI). In stepwise multiple regression analysis, hypertension (b¼0.344, P¼0.009), S-Cr (b¼0.287, P¼0.03) and 2-h PG (b¼0.274, P¼0.03) were independently associated with renal arterioarteriolosclerosis. Eleven of the 30 hypertensive patients did not have renal arterio-arteriolosclerosis. The hypertensive patients with renal arterio-arteriolosclerosis showed significantly higher 2-h PG (134 ± 25 vs. 106 ± 26 mg per 100 ml, P¼0.008) and higher 2-h PI (67.7 ± 34.9 vs. 48.3 ± 30.0 lU ml À1 , P¼0.04) compared with those without renal arterio-arteriolosclerosis, but the difference in S-Cr was not significant. Postprandial hyperglycemia and hyperinsulinemia may contribute to the formation of renal arterio-arteriolosclerosis independently of hypertension.

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Severity of arterial and/or arteriolar sclerosis in IgA nephropathy and the effects of renin–angiotensin system inhibitors on its prognosis

Sugiura

Moriyama

Miyabe

et al. 2021

The Journal of Pathology CR

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IgA nephropathy (IgAN) patients often suffer from arterial and/or arteriolar sclerosis (AAS); however, it is unclear whether these features are associated with a poor prognosis. This retrospective cohort study aimed to analyse the prognosis of IgAN patients with AAS and assess whether treatment with renin–angiotensin system inhibitors (RASI) improved their survival. The study included 678 IgAN patients, who were grouped into AAS0 (n = 340; AAS absent) and AAS1 (n = 338; AAS present) groups. Each patient's clinical, laboratory, and histological backgrounds and 20‐year renal prognosis were analysed. In the AAS1 group, the impact of RASI initiated during the follow‐up period on the renal prognosis was also evaluated after adjustments for background characteristics. IgAN patients with AAS had significantly higher age, blood pressure, body mass index, total cholesterol, uric acid levels, and proteinuria than patients without AAS; they also had more severe histological findings, decreased renal function, and lower survival rates than those without AAS (64.0 versus 84.7%, p < 0.001). Multivariate Cox regression analysis incorporating clinical and histological findings and treatments revealed AAS as an independent factor for disease progression (hazard ratio: 2.23, p = 0.010). Participants in the AAS1 group treated with RASI during follow‐up had a significantly higher renal survival rate than those who were not (75.5 versus 44.3%, p = 0.013). In conclusion, AAS was found to be associated with serious clinical, laboratory, and histological findings and poor prognosis. RASI initiated during the follow‐up period was found to improve renal prognosis.

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Characteristics and risk factors of intrarenal arterial lesions in patients with IgA nephropathy

Cited by 68 publications

References 11 publications

A Clinicopathologic Study of Thrombotic Microangiopathy in IgA Nephropathy

A Clinicopathologic Study of Thrombotic Microangiopathy in IgA Nephropathy

Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

Severity of arterial and/or arteriolar sclerosis in IgA nephropathy and the effects of renin–angiotensin system inhibitors on its prognosis

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