Chronicity index and mesangial IgG deposition are risk factors for hypertension and renal failure in early IgA nephropathy

Nieuwhof, C.; Kruytzer, M.; Frederiks, Pascal; Vriesman, P. J. C. Van Breda

doi:10.1053/ajkd.1998.v31.pm9631840

Cited by 68 publications

(55 citation statements)

References 27 publications

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“…Furthermore, these same clinical features at presentation were also correlated with the risk of disease progression, as determined by the subsequent occurrence of clinical events such as impairment of renal functio and development of significant proteinuria and hypertension on follow-up. Such observations are also similar to those in primary IgA nephropathy (15,16,19). Although end-stage renal failure only affected three patients in this series and is in keeping with the observations in the literature, such an infrequent outcome remains to be confirmed by larger series (3, 8, 10 -13).…”

Section: Figuresupporting

confidence: 91%

“…Periodic acid silver methenamine, ϫ360. stresses the similarity between HSP nephritis and primary IgA nephropathy by way of their clinical prognostic features (3,7,9,11,13,14,16,19). Furthermore, these same clinical features at presentation were also correlated with the risk of disease progression, as determined by the subsequent occurrence of clinical events such as impairment of renal functio and development of significant proteinuria and hypertension on follow-up.…”

Section: Figurementioning

confidence: 82%

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Grading of Acute and Chronic Renal Lesions in Henoch-Schönlein Purpura

Szeto

Choi

et al. 2001

Modern Pathology

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The renal outcome of 34 patients with HenochSchönlein purpura nephritis was assessed clinically and by grading acute and chronic renal lesions using a system we applied to primary IgA nephropathy. On a median follow-up period of 65 months, hypertension and the serum levels of creatinine and proteinuria at the time of renal biopsy were correlated with renal survival. Acute glomerular lesions including mesangial hypercellularity, endocapillary proliferation, necrosis, cellular crescents, and leukocytes infiltration were observed, respectively, in 41%, 12%, 50%, 29%, and 32% of the cases. Of these, only glomerular necrotizing lesion and cellular crescent were correlated with the renal survival. Chronic renal lesions based on a grading system applied to primary IgA nephropathy and assessing the extent of glomerular sclerosis (glomerular grading), of tubular loss and interstitial fibrosis (tubulointerstitial grading), and of hyaline arteriolosclerosis demonstrated correlation between these lesions, as well as with renal survival. On follow-up, these chronic renal lesions were predictors of subsequent clinical events associated with disease progression, such as impaired renal function, significant proteinuria, and development of hypertension. Despite some limitations related to the relatively small size, this series indicates that distinction of acute and chronic lesions of Henoch-Schonlein purpura nephritis is important for both the prognosis and management of patients.

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Section: Figuresupporting

confidence: 91%

Section: Figurementioning

confidence: 82%

Grading of Acute and Chronic Renal Lesions in Henoch-Schönlein Purpura

Szeto

Choi

et al. 2001

Modern Pathology

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“…Waldo (3) suggested that IgG locates at sites of complement fixation, and that local complement activation mediated by deposited IgG is essential to mesangial cell proliferation and subsequent renal injury. In fact, mesangial IgG deposition is a reported risk factor for hypertension and renal failure in IgAN (24). Considering these factors, C3 consumption appears to be essential for the progression of IgAN.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Serum IgA/C3 Ratio and Progression of IgA Nephropathy

et al. 2004

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Objective The serum IgA/C3 ratio might be considered to serve as a diagnostic marker for patients with IgA nephropathy (IgAN), but its value as a marker of the severity of histological lesions or prognosis is unknown.Methods We studied the serum IgA/C3 ratio, using standardized reference material, in 86 patients with IgAN and in 32 with non-IgAN. The patients with IgAN were divided according to the severity of histological lesions (mild IgAN, n=29 and severe IgAN, n=57) based on Japanese clinical guidelines.Results The serum IgA level was significantly higher, while its C3 level was lower in patients with severe IgAN compared to those with non-IgAN. However, these levels were not different between patients with mild IgAN and non-IgAN. In contrast, the serum IgA/C3 ratio obviously differed among the three groups (2.47±0.96 vs. 3.63±1.44 vs. 4.72±1.86; p<0.01, ANOVA). Kaplan-Meier analysis of the patients with IgAN classified according to the mean serum IgA/C3 ratio revealed that the group with high serum IgA/C3 (4.5 and above) had a significantly poorer renal outcome (p<0.05, log-rank test), since the cumulative renal survival rate at 5 years was 84.4% vs. 100%. The ratio (%) of patients with severe IgAN in whom hematuria disappeared, was significantly higher in the low, than in the high serum IgA/C3 group (41.9% vs. 15.4%; p<0.05, t-test).Conclusion The serum IgA/C3 ratio appears to reflect the histological severity of IgAN and could serve as a marker of the progression of IgAN.

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“…Interstitial infiltration was graded according to Nieuwhof's study (17): grade 0, absent; grade 1, focal interstitial infiltration; grade 2, multiple foci of interstitial infiltration; grade 3, diffuse interstitial infiltration.…”

Section: Histopathological Evaluationmentioning

confidence: 99%