An important role of glomerular segmental lesions on progression of IgA nephropathy: a multivariate analysis

Katafuchi, Ritsuko; Oh, Youngman; Hori, Keiichi; Komota, Tetsuo; Yanase, Tetsuro; Ikeda, Kiyoshi; Omura, Takashi; Fujimi, Satoshi

doi:10.1007/bf00860749

Cited by 59 publications

(52 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This suggested that heavy proteinuria at presentation might partially reflect an already advanced renal injury and/or impaired renal function. Furthermore, arterial hypertension was found to be associated with progression of IgAN in several studies (4,5,7); however, in some studies from Japan, including this study, it was not found to be a predictor of progression (2,17,18). These differences may be due in part to the differences in the biopsy policies and to the stage of the diseases (19).…”

Section: Discussioncontrasting

confidence: 60%

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

Tsuboi¹,

Kawamura²,

Koike³

et al. 2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: An early histopathologic predictor of the renal prognosis, before the occurrence of advanced glomerular sclerosis/interstitial fibrosis and/or apparent renal dysfunction, remains to be established in IgA nephropathy (IgAN). This study aimed to determine whether the glomerular density (GD; nonsclerotic glomerular number per renal cortical area) of biopsy specimens obtained at an early stage of IgAN could predict the long-term renal outcome.Design, setting, participants, & measurements: The predictive value of the factors at biopsy, including the GD, on the renal outcome was retrospectively analyzed for 98 patients who had IgAN with an estimated GFR of >60 ml/min per 1.73 m 2 at biopsy (87 ml/min per 1.73 m 2 on average). Results: The individual value of GD in biopsy ranged from 1.2 to 8.1/mm 2 (i.e., approximately a seven-fold variation), and the GD showed a close inverse correlation with mean glomerular volume. Among the various clinicopathologic factors involved, both a cellular/fibrocellular crescent and the GD were found to be significant predictors of progression in multivariate analyses. A low GD in the biopsy specimens was frequently associated with a steeper slope of the renal function and a synergistically enhanced risk for progression with the presence of cellular/fibrocellular crescent. The renal function, proteinuria, degrees of glomerulosclerosis, and interstitial fibrosis at biopsy were not independent predictors of the prognosis in these patients.Conclusions: A strong predictive relationship of low GD with progression observed in this study suggests that GD may serve as an early histopathologic marker of long-term renal prognosis in IgAN.

show abstract

Section: Discussioncontrasting

confidence: 60%

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

Tsuboi¹,

Kawamura²,

Koike³

et al. 2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…[5][6][7][8][9][10][11][12] This variability in long-term outcome of patients with IgA nephropathy may reflect differences in genetic influences, frequency of urinary screening, and criteria for renal biopsy. A review of patients from 3 continents suggests that a lead-time bias in establishing the diagnosis contributes to the variation in long-term outcomes by different centers.…”

Section: Discussionmentioning

confidence: 99%

“…4 In the last 20 years, many studies involving large cohorts of patients reported clinical, laboratory, and pathological characteristics that predict progressive renal disease. [5][6][7][8][9][10][11][12] Impaired renal function at the time of renal biopsy, high glomerular histopathologic scores, proteinuria with protein greater than 1 g/24 h, and hypertension have emerged as strong predictors of poor renal survival.…”

mentioning

confidence: 99%

IgA Nephropathy: The Presence of Familial Disease Does Not Confer an Increased Risk for Progression

Izzi

Ravani

Torres

et al. 2006

American Journal of Kidney Diseases

View full text Add to dashboard Cite

• Background: Immunoglobulin A (IgA) nephropathy is the most common form of glomerulonephritis worldwide. Familial and sporadic cases are recognized, and a locus associated with the familial form of the disease was mapped to chromosome 6. Recent data suggest the familial IgA nephropathy form may have a poorer outcome than the sporadic form. Methods: We tested the hypothesis of unequal survival rates between the 2 forms of disease by analyzing time from biopsy to end-stage renal disease in patients of Italian ancestry; 589 patients with sporadic and 96 patients with familial IgA nephropathy. Results: Overall 10-and 20-year renal survival probabilities of the cohort as a whole were 71% and 50%, respectively. Macroscopic hematuria was the modality of clinical presentation in 51% of patients with familial IgA nephropathy and 39% of patients with sporadic IgA nephropathy. At univariable analysis, the sporadic form of IgA nephropathy was associated significantly with increased risk for renal death. However, patients with the sporadic form tended to be more hypertensive and diagnosed later, with signs of more advanced renal disease than those with familial disease at baseline. In the regression model, form of disease lost any independent effect. Only male sex, lower baseline glomerular filtration rate, greater proteinuria, and histopathologic score proved to be independent predictors of disease progression. Treatment with steroids or angiotensinconverting enzyme inhibitors was associated with improved outcomes. Conclusion: Our study does not confirm that familial IgA nephropathy has a worse prognosis than the sporadic form. The similar renal phenotype may support a common pathogenic mechanism underlying familial and sporadic IgA nephropathy.

show abstract

“…Patients with IgAN have a variable clinical course with between 6 and 43% progressing to ESRD over 10 yr (1)(2)(3)(4)(5). Given this variability, identifying reliable prognostic factors is important to help stratify clinical monitoring and treatment regimens.…”

mentioning

confidence: 99%

“…This is not surprising considering that these features are a common final result of damage from glomerulonephritis; however, histopathologic features frequently correlate with serum creatinine, and whether they add prognostic values beyond the measurement of serum creatinine is uncertain. Histopathologic features are commonly categorized on the basis of arbitrary thresholds to denote significant degrees of damage (3,5,11), a factor that may contribute to poor performance in multivariable models of risk prediction in IgAN and result in an underestimation of their ability independently to predict outcomes. We performed a retrospective study using detailed baseline clinical data and quantitative analysis of renal biopsies, including the degree of interstitial fibrosis and glomerulosclerosis, to assess the factors that determine adverse outcomes including chronic kidney disease (CKD) progression and death.…”

mentioning

confidence: 99%

Histopathologic Features Aid in Predicting Risk for Progression of IgA Nephropathy

Walsh¹,

Sar

Lee³

et al. 2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Accurately identifying patients who are at risk for progressive disease is challenging. The extent to which histopathologic features improves prognostication is uncertain.Design, setting, participants, & measurements: We studied a retrospective cohort with biopsy-proven IgAN in Calgary, Canada. Renal biopsies were reviewed by a nephropathologist with histopathologic data abstracted using a standardized form. The primary outcome was the composite of doubling of serum creatinine, ESRD, or death. Spline models defined significant levels of interstitial fibrosis, glomerulosclerosis, hypertension, proteinuria, and creatinine. The prognostic significances of clinical and histopathologic parameters were determined using Cox proportional hazards models.Results: Data from 146 cases were available for analysis with a median follow-up of 5.8 years. Greater than 25% interstitial fibrosis, >40% glomerular sclerosis, and a systolic BP >150 mmHg were risk thresholds. In univariable analyses, baseline creatinine, proteinuria, systolic BP, glomerular sclerosis, interstitial fibrosis, and crescentic disease were predictors of the primary outcome. In multivariable models adjusted for clinical characteristics, interstitial fibrosis (hazard ratio [HR]2.7; 95% confidence interval [CI] 1.2 to 6.0), glomerular sclerosis (HR 2.6; 95% CI 1.2 to 4.5), and crescents (HR 2.4; 95% CI 1.2 to 5.1) remained independent predictors of the primary outcome and significantly improved model fit compared with clinical characteristics alone.Conclusions: Baseline histopathologic parameters are independent predictors of adverse outcomes in IgAN even after taking into consideration clinical characteristics. Relatively small degrees of interstitial fibrosis confer an increased risk for progressive IgAN.

show abstract

An important role of glomerular segmental lesions on progression of IgA nephropathy: a multivariate analysis

Cited by 59 publications

References 0 publications

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

IgA Nephropathy: The Presence of Familial Disease Does Not Confer an Increased Risk for Progression

Histopathologic Features Aid in Predicting Risk for Progression of IgA Nephropathy

Contact Info

Product

Resources

About