Outcome of IgA nephropathy in adults graded by chronic histological lesions

To, Ka Fai; Choi, Pui–Wah; Szeto, Cheuk‐Chun; Li, Philip K.T.; Tang, Nelson L.S.; Leung, Chi Bon; Wang, Angela Yee-Moon; Ho, Kelvin K.L.; Wong, Teresa Yuk‐Hwa; Lui, Sui Fai; Lai, Fernand M.M.

doi:10.1016/s0272-6386(00)70191-0

Cited by 61 publications

(55 citation statements)

References 16 publications

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“…The values for the grading system used ranged from 0.834 to 1.0 with a P Ͻ .0001 for all histological parameters examined in HSP nephritis and were similar to the results observed in previous studies in primary IgA nephropathy (14,15).…”

Section: Resultssupporting

confidence: 83%

“…We examined the clinical and morphologic features of HSP patients who underwent biopsy for renal manifestations and assume that these selected patients carry a higher risk of disease progression, similar to that of many patients with primary IgA nephropathy (6, 7-9, 11-13). Our objective was to determine whether the histological grading of primary IgA nephropathy can also apply to HSP nephritis and whether the distinction between acute and chronic renal lesions can be predictive of the renal outcome (3,7,11,14).…”

Section: Discussionmentioning

confidence: 99%

“…The selection criteria included the following: (1) a diagnosis of IgA nephropathy based on predominant mesangial IgA-containing immune complexes in immunofluorescent and electron microscopies, excluding patients with diabetes, systemic lupus erythematosus, chronic liver diseases, and renal allograft (14,15); (2) a nonthrombocytopenic purpura, with or without arthritis or gastrointestinal symptoms; (3) a minimum follow-up of 12 months; and (4) for light microscopy, Ն5 mm of renal cortex, 10 glomeruli, and 3 arterioles. Excluded were three patients who died within 6 months (of septicemia, severe vasculitis, and liver failure), two who underwent repeat biopsy, seven who were lost to follow-up, three who had insufficient biopsy materials, and three with Ͻ12 months of follow-up.…”

Section: Patient Selection and Clinical Parametersmentioning

confidence: 99%

“…The pathology assessment and grading were reported elsewhere (14,15). In brief, the biopsy sections were independently scored by two of us (PCLC, FMML), and the results were correlated by values.…”

Section: Pathology Assessmentmentioning

confidence: 99%

“…The tubular atrophy and interstitial fibrosis in cortex were also estimated in percentages and were graded as TIG1 (when these were absent or Ͻ5%), TIG2 (when these were 5% to Ͻ50%), and TIG3 (when these were Ն50%). HA was recorded for arteriolar hyaline changes, with or without smooth muscle hyperplasia (14).…”

Section: Pathology Assessmentmentioning

confidence: 99%

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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: Resultssupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Patient Selection and Clinical Parametersmentioning

confidence: 99%

Section: Pathology Assessmentmentioning

confidence: 99%

Section: Pathology Assessmentmentioning

confidence: 99%

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