IgA Nephropathy: A Comparative Study of the Clinicopathologic Features in Children and Adults

Mina, Samir N.; Murphy, William M.

doi:10.1093/ajcp/83.6.669

Cited by 32 publications

(15 citation statements)

References 6 publications

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“…Several factors are known to adversely affect prognosis in IgAN: male gender [4, 26, 31], old age [11, 22, 23], hypertension [4, 5, 7, 11, 12, 22, 23], heavy proteinuria [4, 5, 7, 9, 11, 12, 22], increased S-Cr [4, 5, 7], high serum IgA concentration [7], HLA-B35 antigen [7], and histopathologic severity [4, 5, 7, 11, 28, 30, 31]. Increased S-Cr, proteinuria, and hypertension are the major clinical markers of unfavorable renal outcome proposed by many investigators, irrespective of whether or not the factors are mutually dependent.…”

Section: Discussionmentioning

confidence: 99%

“…Levels of proteinuria considered to affect renal outcome have varied widely; for instance, some investigators have considered proteinuria ≥1.0 g/24 h to predict poor outcome [1, 2, 10, 14, 15, 17, 21], others ≥2.0 g/24 h [5, 12, 20, 25]or ≥3.0 g/24 h [7, 8, 18], and still others ≥3.5 g/24 h [4, 19]; even so, some authors have found proteinuria to have little predictive value [7, 26, 27, 28, 29]. On the other hand, a large number of reports have favored various histopathologic changes, such as glomerular sclerosis and tubulointerstitial lesions, over clinical laboratory data in predicting the outcome of the disease [1, 4, 7, 8, 11, 15, 18, 19, 28, 30, 31, 32, 33]. …”

Section: Introductionmentioning

confidence: 99%

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Clinicopathologic Study on Prognostic Markers in IgA Nephropathy

Mera¹,

Uchida²,

Nagase³

2000

Nephron

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Background/Aim: Few prognostic markers have found general acceptance in IgA nephropathy (IgAN). The aim of the present study was to search for significant predictor(s) at the time of biopsy. Methods: Fifty-five patients with IgAN undergoing evaluation and treatment at our institution were examined regarding clinicopathologic features at the time of renal biopsy and, if possible, at follow-up. Factors predictive of outcome were evaluated. Renal histopathology was quantified using a glomerulosclerosis index (GSI), a tubulointerstitial index (TII), and a crescent index (CI). Results: The serum creatinine concentration (S-Cr) showed positive correlations with proteinuria and serum total cholesterol concentration, as well as with histopathologic findings. Heavy proteinuria (≧3.0 g/24 h) was associated with higher S-Cr and greater severity of pathologic abnormalities than with milder proteinuria. At follow-up, 6 patients progressed to chronic renal insufficiency, in whom the S-Cr increased by at least 50% to reach or exceed 1.5 mg/dl (132.6 µmol/l). By univariate analysis, elevated GSI, TII, and S-Cr, presence of nephrotic syndrome, elevated CI, and elevated total cholesterol were found to be negative predictors, in descending order of odds ratio. In multivariate analysis, however, only TII independently predicted unfavorable outcome. Conclusion: Renal biopsy in IgAN may be the most powerful predictor for renal outcome; an advanced tubulointerstitial lesion is unfavorable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinicopathologic Study on Prognostic Markers in IgA Nephropathy

Mera¹,

Uchida²,

Nagase³

2000

Nephron

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“…1,[8][9][10] Reports comparing lesions in renal biopsies of children and adults with IgAN found greater mesangial hypercellularity in children and greater glomerular sclerosis, matrix expansion, crescent formation, severe interstitial, and arteriolar changes in adults. [11][12][13][14][15] This observation suggests different initial pathological features and/or earlier detection in children. Furthermore, whether the predictive value of biopsy lesions in IgAN applies similarly across the age spectrum using multivariate analysis, including also clinical data, has never been investigated.…”

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confidence: 99%

The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults

Coppo

Troyanov

Camilla

et al. 2010

Kidney International

182

110

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To study the predictive value of biopsy lesions in IgA nephropathy in a range of patient ages we retrospectively analyzed the cohort that was used to derive a new classification system for IgA nephropathy. A total of 206 adults and 59 children with proteinuria over 0.5 g/24 h/1.73 m(2) and an eGFR of stage-3 or better were followed for a median of 69 months. At the time of biopsy, compared with adults children had a more frequent history of macroscopic hematuria, lower adjusted blood pressure, and higher eGFR but similar proteinuria. Although their outcome was similar to that of adults, children had received more immunosuppressants and achieved a lower follow-up proteinuria. Renal biopsies were scored for variables identified by an iterative process as reproducible and independent of other lesions. Compared with adults, children had significantly more mesangial and endocapillary hypercellularity, and less segmental glomerulosclerosis and tubulointerstitial damage, the four variables previously identified to predict outcome independent of clinical assessment. Despite these differences, our study found that the cross-sectional correlation between pathology and proteinuria was similar in adults and children. The predictive value of each specific lesion on the rate of decline of renal function or renal survival in IgA nephropathy was not different between children and adults.

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“…Gross and persistent microhematuria occurs in more than 50% of patients [5]. Episodes of hematuria, at times gross hematuria, often occur in association with infections and stress.…”

Section: Clinical Presentationmentioning

confidence: 99%

The Value of Electron Microscopy in the Diagnosis of IgA Nephropathy

Gu¹,

Herrera²

2002

Ultrastructural Pathology

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Electron microscopy plays a fundamental role in the evaluation of renal diseases in general. IgA nephropathy represents a heterogeneous disease clinically and morphologically. There are a number of conditions that need to be considered in the differential diagnosis of IgA nephropathy. The renal pathologist must wisely integrate the light microscopic, immunofluorescence, and ultrastructural data when evaluating cases in which IgA nephropathy is a consideration. Electron microscopy can be crucial in providing information either to support a diagnosis of IgA nephropathy or to aid in the diagnosis of one of its mimics.

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IgA Nephropathy: A Comparative Study of the Clinicopathologic Features in Children and Adults

Cited by 32 publications

References 6 publications

Clinicopathologic Study on Prognostic Markers in IgA Nephropathy

Clinicopathologic Study on Prognostic Markers in IgA Nephropathy

The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults

The Value of Electron Microscopy in the Diagnosis of IgA Nephropathy

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