IgA nephropathy in Greece: data from the registry of the Hellenic Society of Nephrology

Abstract

BackgroundNatural history, predisposing factors to an unfavourable outcome and the effect of various therapeutic regimens were evaluated in a cohort of 457 patients with immunoglobulin A nephropathy (IgAN) and follow-up of at least 12 months.MethodsPatients with normal renal function and proteinuria <1 g/24 h as well as those with serum creatinine (SCr) >2.5 mg/dL and/or severe glomerulosclerosis received no treatment. Patients with normal or impaired renal function and proteinuria >1 g/24 h for >6 months received daily oral prednisolone or a 3-day course of intravenous (IV) methylprednisolone followed by oral prednisolone per os every other day or a combination of prednisolone and azathioprine. The clinical outcome was estimated using the primary endpoints of end-stage renal disease and/or doubling of baseline SCr.ResultsThe overall 10-year renal survival was 90.8%, while end-stage renal disease and doubling of baseline SCr developed in 9.2% and 14.7% of patients, respectively. Risk factors related to the primary endpoints were elevated baseline SCr, arterial hypertension, persistent proteinuria >0.5 g/24 h and severity of tubulointerstial fibrosis. There was no difference in the clinical outcome of patients treated by the two regimens of corticosteroids; nevertheless, remission of proteinuria was more frequent in patients who received IV methylprednisolone (P = 0.000). The combination of prednisolone with azathioprine was not superior to IV methylprednisolone followed by oral prednisolone. Side effects related to immunossuppressive drugs were observed in 12.8% of patients.ConclusionThe clinical outcome of patients with IgAN was related to the severity of clinical and histological involvement. The addition of azathioprine to a corticosteroid-based regimen for IgAN does not improve renal outcome.

Clinical Efficacy of Huangkui Capsule Plus Methylprednisolone for Immunoglobulin A Nephropathy and Its Effect on Renal Function and Serum Inflammatory Factors

“…Glucocorticoids are commonly used in the treatment of patients with IgA nephropathy as they improve the permeability of the glomerular membrane, facilitate urination, and reduce the level of urinary protein. Stangou et al [ 12 ] found that glucocorticoids also inhibited the inflammation and immune response in patients with IgA nephropathy. Methylprednisolone is a medium-acting glucocorticoid that regulates the cellular and humoral immunity, thereby enhancing the immune function of the patients [ 13 ].…”

Validation of the International IgA Nephropathy Prediction Tool in the Greek Registry of IgA Nephropathy

“…In this study, we validated two risk-prediction models which accurately predict a 50% decline in eGFR or ESKD in patients with IgAN using the available data set from the national IgAN registry of the Greek society of Nephrology ( 8 ). From this data set, we extracted and used the clinical and histological information from patients with available MEST scores.…”

“…In this study, we included patients from the Greek Society of Nephrology IgAN registry ( 8 ). In this registry, patients with biopsy-proven IgAN are reported independently for research purposes from different nephrology departments across Greece.…”

The Oxford Classification of IgA nephropathy: A review of literature

“…If treated aggressively, C lesions were not associated with a worse outcome. 22 Similarly, Troyanov et al in their validation analysis also mentioned that M lesions may not be associated with proteinuria, and they questioned the validity of the M score. In addition, it has been the parameter with the worst reproducibility among pathologists.…”