Clinical and histopathological spectrum of IgA nephropathy in Kuwait

Abstract

BACKGROUND:Little is known about the nature and the course of IgA nephropathy (IgAN) in Arab countries. The aim of this work was to study the spectrum of clinical presentation and histopathological findings at our institution.DESIGN AND SETTING:Retrospective review, all renal biopsies at the Mubarak Al Kabeer Hospital between January 2000 and December 2004.METHODS:Cases of IgA nephropathy were selected, and their medical records and biopsy findings were reviewed.RESULTS:Eighty patients (9.2% of all native kidney biopsies) were diagnosed to have IgAN nephropathy. Sixty-nine biopsies were included in the study;11 were excluded. Forty-three (62.3%) patients were male and 26 (37.7) patients were female. Fifty (72.5%) patients were below the age of 40 years. Mean (SD) duration of follow-up was 3.6 (1.3) years. The first presentation included nephritic-range proteinuria (49.3%) and renal impairment (50.7%). During the follow-up period, 56 (81.2%) patients were stable or improved. Hass classification of biopsies showed 36.2% had class I, 27.5% had class II, 13.0% had class III, 5.8% had class IV, and 17.4% had class V IgAN. Females had milder forms of the disease than males. Macroscopic hematuria and renal impairment at presentation were seen more in patients with class IV and V IgAN. The presenting serum creatinine and uric acid values were higher in those with Hass classes III to V. Deterioration of renal function during the follow-up period was more significant in the presence of hypertension, renal impairment, or macroscopic hematuria at the time of biopsy .CONCLUSION:The prevalence of IgAN in Kuwait is about 9.2%. Renal impairment or macroscopic hematuria at presentation was seen in patients with more aggressive renal lesions and contributed to poor outcome.

Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

“…Multivariable logistic regression showed that the presence of mild hematuria was a significant predictor (OR, 2.3; 95% CI, 1.2–4.3). A Kuwait study [ 38 ] with 69 IgAN patients suggested that deterioration of renal function during the follow-up period (mean follow-up duration, 3.5 years) was more significant in the presence of macroscopic hematuria at the time of biopsy ( p < .05). The crude RR was 1.47 (95% CI, 0.90–2.40).…”

Podocytes are likely the therapeutic target of IgA nephropathy with isolated hematuria: Evidence from repeat renal biopsy

“…A meta-analysis of 5,660 IgAN patients from 13 literatures (He et al, 2021) concluded that initial microscopic hematuria and persistent hematuria may be associated with renal progression and ESRD. A Kuwaiti study of 69 IgAN patients (Ghani et al, 2011) showed that renal function deterioration was more significant during follow-up (mean followup 3.5 years) in the presence of gross hematuria at biopsy. Our center has been paying close attention to IgAN patients with hematuria.…”

Time Averaged Uric Acid Is Associated With the Prognosis of IgAN in Females

“…It is therefore clear that the role of serum uric acid in IgAN is still controversial. Nonetheless, a large number of previous studies rarely included the analysis of pathological data and the baseline value of serum uric acid at renal biopsy was used as the research index (Ghani et al 2011;Le et al 2012;Liu et al 2018;Matsukuma et al 2017;Moriyama et al 2015;Nagasawa et al 2016). However, the baseline value of serum uric acid may not accurately re ect the dynamic level of serum uric acid during the follow-up period because the level of blood uric acid uctuates greatly and is easily affected by speci c food and eating habits (Roddy et al 2018).…”