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

He, Ping; Wang, Hanmin; Huang, Chen; He, Lijie

doi:10.1080/0886022x.2021.1879852

Cited by 16 publications

(14 citation statements)

References 39 publications

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“…Although hematuria is a typical presentation of IgAN, its long-term prognostic value remains under debate. A recently published meta-analysis of 7 studies investigated the association between hematuria (binary variable) and ESKD [ 35 ]. They reported that initial hematuria was not associated with a significant increase in the risk of ESKD [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recently published meta-analysis of 7 studies investigated the association between hematuria (binary variable) and ESKD [ 35 ]. They reported that initial hematuria was not associated with a significant increase in the risk of ESKD [ 35 ]. Of note, the average age of patients ranged from 30 to 45 in the meta-analysis, which may explain the discrepancy [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological characteristics and risk factors in elderly patients with biopsy-proven IgA nephropathy

et al. 2022

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Background Immunoglobulin A nephropathy (IgAN) has been well studied among young people, but few data on clinicopathological characteristics, treatment response and outcomes for elderly IgAN patients are available. Methods A cohort study of elderly IgAN patients was performed. The combined endpoints of renal outcome were a 50% decline in eGFR compared with the time of renal biopsy, end-stage kidney disease and/or death. Risk factors associated with poor renal outcomes were then determined. The benefits of immunosuppressant therapies were also evaluated by Kaplan-Meier survival curve analysis. Results This study ultimately included 126 elderly patients with IgAN. Comparison between the endpoint and non-endpoint groups indicated that patients with poor outcomes had more severe clinical features, such as worse kidney function, severe hematuria and lower albumin levels. Cox regression analysis indicated that age (HR 1.15, 95% CI 1.02–1.29, p = 0.021), male gender (HR 9.71, 95% CI 1.00–97.56, p = 0.050), and urine red blood cells (HR 1.003, 95% CI 1.000–1.006, p = 0.029) were independent risk factors for poor renal outcome in elderly IgAN patients. To explore possible reasons accounting for the predictive value of age and sex, patients were divided into two groups based on these two variables. Patients in the geriatric group had lower serum albumin, estimated glomerular filtration rate, hemoglobin and aspartate aminotransferase levels than those in the quinquagenarian group. Male patients tended to have higher hemoglobin, higher alanine aminotransferase, and lower triglycerides and cholesterol levels than female patients. To investigate different treatment responses, patients were classified into two groups depending on treatment strategies (renin-angiotensin system inhibitors and immunosuppressive therapy), and the survival analysis indicated no significant difference in kidney outcome between the two groups ( p > 0.05). This result still holds after adjusting for age, sex, eGFR, hematuria, and proteinuria. Conclusion Advanced age, male, and hematuria might be independently associated with poor kidney outcomes in elderly patients with IgAN. Immunosuppressive therapy might confer no overall benefit to older IgAN patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and risk factors in elderly patients with biopsy-proven IgA nephropathy

et al. 2022

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“…There was a significant interaction between Frontiers in Pharmacology frontiersin.org remission of proteinuria and remission of hematuria in the 6 months prior to treatment. 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.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, more and more scholars called on clinicians to pay attention to the influence of hematuria on IgAN. Both prospective clinical cohort studies (Yu et al, 2020) and metaanalysis (He et al, 2021) proved that hematuria was one of the risk factors for progression of IgAN, and both the degree and duration of hematuria affected the prognosis of the disease (Yu et al, 2020). Compared with patients with mild or negative hematuria, the others with persistent hematuria will more easily develop into ESRD over time.…”

Section: Introductionmentioning

confidence: 99%

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

Luo

Yin

et al. 2023

Front. Pharmacol.

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Background: The present study aimed to prove the progression of immunoglobulin A nephropathy (IgAN) patients with isolated hematuria based on repeat renal biopsy data for the first time.Methods: 29 IgAN patients with isolated hematuria who received repeat renal biopsies were analyzed retrospectively, while 29 non-isolated hematuria IgAN patients with similar age and background were randomly selected as the control group. Clinical parameters were collected at the time of biopsy. The treatment strategies (conservative treatment with RASS blocker or immunosuppressive treatment) were choosen according to the pathological results at the first renal biopsy. The activity and chronicity indexes of renal lesions were evaluated. Markers of cell inflammation and proliferation were tseted by immunochemistry. The ultrastructure of podocytes was observed by transmission electron microscopy (TEM). Podocyte and oxidative stress marker (NPHS2 and 4-HNE) were detected by immunofluorescence.Results: The IgAN patients with isolated hematuria had better clinical indicators than those with no-isolated hematuria, such as better renal function, higher albumin and lower uric acid. The interval between two biopsies in IgAN patients with isolated hematuria was 630 (interquartile range, 409.5–1,171) days. The hematuria of the patients decreased significantly from 30 (IQR, 4.00–35.00) RBC/ul in the first biopsy to 11 (IQR, 2.50–30.00) RBC/ul in the repeated biopsy (p < 0.05). The level of triglyceride decreased significantly (p < 0.05). The other clinical indicators were not statistically significant (p > 0.05). Deposits of IgA and C3 in the glomerulus were persistent. The activity index decreased, especially cellular crescent formation, while the chronicity index increased. The ultrastructure of podocytes was improved after treatment. The oxidative stress products of podocytes reduced after treatment.Conclusion: Although the clinical indicators of the IgAN patients with isolated hematuria were in the normal range, various acute and chronic pathological changes have occurred, and irreversible chronic changes have been progressing. Cell inflammation and proliferation persisted. Oxidative stress of podocytes was likely to be the therapeutic target. This study provided a strong basis for the progress of IgAN with isolated hematuria through pathological changes before and after treatment. This study will help clinicians recognize the harm of hematuria, change the traditional treatment concept, and help such patients get early treatment.

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“…3 A meta-analysis from 13 studies with 5660 participants reported that baseline microscopic haematuria was associated with an 87% increase in the risk of kidney failure. 4 In STOP-IgAN trial which compared intensive supportive care with and without immunosuppressive therapy in patients with IgAN and proteinuria >0.75 g/day and/or impaired kidney function (eGFR <90 mL/min/1.73 m 2 ), disappearance of microscopic haematuria determined by dipstick or urinary sediment analysis was assessed as a secondary endpoint. 5 Haematuria remission was significantly greater in the immunosuppressive group compared to the supportive care group (42% vs. 16%, respectively; OR 3.73 [95% CI, 1.52-9.14]; p = .004).…”

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confidence: 99%

Haematuria in immunoglobulin a nephropathy: To be or not to be?

Sun,

Wong

2024

Nephrology

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Microscopic haematuria is one of the characteristics and present in 70%-100% of individuals with Immunoglobulin A nephropathy (IgAN).Haematuria results from glomerular capillary wall damage secondary to inflammatory process triggered by IgA immune complex deposition.Its presence often serves as a clinical indicator of active glomerular inflammation. Persistent or recurrent haematuria, despite a reduction in proteinuria, has been linked to an increased risk of progression to kidney failure and higher rates of disease relapse. Therefore, understanding the significance of microscopic haematuria in IgAN is useful for clinicians to guide therapy. However, its clinical correlation with disease activity and risk of kidney progression remains equivocal, often limited by its methods of detection.The retrospective, registry-based, nationwide, real-world study by Yano et al. aimed to evaluate whether long-term dipstick haematuria and proteinuria trajectory patterns were predictive of kidney events in patients with IgAN. It found that the highest risk of a >50% eGFR decline was associated with the high-stable trajectory haematuria and proteinuria groups. Furthermore, when the proteinuria trajectory groups were subcategorized according to haematuria patterns, those with high-stable and modest-stable haematuria were twice as likely to have a worse kidney outcome within the next 4 years compared to those with low-stable haematuria. This suggests that patients with IgAN and persistent haematuria are at greater risk of kidney progression with worse outcomes, regardless of proteinuria trajectory.The Kidney Disease Improving Global Outcomes (KDIGO) guidelines commented that the only validated prognostic biomarkers for IgAN at present are eGFR and proteinuria (practice point 2.2.1). Additionally, haematuria is not included in the International IgAN Prediction Tool, which incorporates blood pressure, proteinuria, eGFR, age, race, use of ACEI inhibitor/ARB and immunosuppression, and histology scores at time of biopsy. There are ongoing debates on incorporating microscopic haematuria in the definition of remission or disease relapse of IgAN.

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

Cited by 16 publications

References 39 publications

Clinicopathological characteristics and risk factors in elderly patients with biopsy-proven IgA nephropathy

Clinicopathological characteristics and risk factors in elderly patients with biopsy-proven IgA nephropathy

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

Haematuria in immunoglobulin a nephropathy: To be or not to be?

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