Factors That Determine an Incomplete Recovery of Renal Function in Macrohematuria-Induced Acute Renal Failure of IgA Nephropathy

Gutiérrez, Eduardo; González, Esther; Hernández, Eduardo; Morales, Enrique; Martı́nez, Miguel Ángel; Usera, Gabriel; Praga, Manuel

doi:10.2215/cjn.02670706

Cited by 85 publications

(94 citation statements)

References 12 publications

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“…Furthermore, gross hematuria occurring in patients with underlying glomerular disease has been associated with the development of transient AKI. This association has been described in patients with IgA nephropathy and warfarin-related nephropathy thin basement membrane disease [20][21][22][23][24]. Taking account of these, glomerular hemorrhage, massive RBC casts, and peritubular capillaritis and interstitial hemorrhage may have involved with the onset of AKI in the present case.…”

Section: Discussionsupporting

confidence: 67%

A case of (double) ANCA-negative granulomatosis with polyangiitis (Wegener’s)

et al. 2012

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A 60-year-old man had experienced cough, bloody sputum, and a 38°C fever for 1.5 months. He visited an outpatient clinic and received antibiotics and nonsteroidal anti-inflammatory drugs. However, because the symptoms continued, he visited our hospital. The past medical history included chronic sinusitis, hypertension, and diabetes mellitus. A chest x-ray film and computed tomography showed multiple pulmonary nodules with cavities.

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Section: Discussionsupporting

confidence: 67%

A case of (double) ANCA-negative granulomatosis with polyangiitis (Wegener’s)

et al. 2012

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“…Reversible macroscopic hematuria-associated acute kidney injury, although rare, has been increasingly described as a complication of IgA nephropathy and complete recovery of baseline renal function after cessation of macroscopic hematuria is being more commonly observed [7]. Though the majority of these patients recover renal function without intervention, the presence of macroscopic hematuria may also portend severe kidney injury, with approximately 30 % of these patients requiring shortterm dialysis [8].…”

Section: Discussionmentioning

confidence: 99%

“…Features known to be associated with poor prognosis in IgA nephropathy include older age at onset, absence of recurrent macroscopic hematuria [7], hypertension, and proteinuria ([500 mg/day); proteinuria is the only parameter that independently predicts the progression of renal dysfunction [9]. Based on these prognostic factors, evidence-based treatment recommendations include prednisone for patients with more than 3 g of proteinuria per day, mild glomerular changes on biopsy, and preserved renal function (eGFR [70 mL/min) [10].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple episodes of transient renal failure with gross hematuria may lead to progressive renal decline at a more gradual rate than the results from a single occurrence of kidney injury [7]. When patients with IgA nephropathy suffer from acute renal failure followed by gross hematuria, possible determinants of prognosis may involve features already associated with a poor prognosis in IgA nephropathy, including older age at onset, absence of recurrent macroscopic hematuria [7], hypertension, and proteinuria [9].…”

Section: Discussionmentioning

confidence: 99%

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Atypical triad of IgA nephropathy: reversible acute kidney injury, gross hematuria, and severe bilateral flank pain

Kim

Chang

2013

CEN Case Rep

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Reversible acute kidney injury very rarely complicates the course of immunoglobulin A (IgA) nephropathy. We report an atypical case of reversible acute kidney injury, gross hematuria, and severe bilateral flank pain as the presenting triad of IgA nephropathy. Renal biopsy revealed mesangial IgA deposition without glomerular crescents. The patient's renal dysfunction, mediated by red cell tubular obstruction, interstitial nephritis, and tubular necrosis, resolved without intervention. We conclude that IgA nephropathy should be considered in the differential diagnosis for transient acute kidney injury with gross hematuria, and should be appropriately treated based on known prognostic factors.

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“…Although all patients improved, at last visit, 9-57 months later, five of seven patients had CKD stage 2 or 3. In 2007, Gutiérrez and coworkers published a larger retrospective study in which 25% of the patients did not recover baseline serum creatinine (7). Univariate analysis identified duration of gross hematuria, age older than 55 years, higher baseline serum creatinine, and absence of previous macroscopic hematuria episodes as prognostic factors for incomplete recovery of renal function.…”

Section: Macroscopic Glomerular Hematuria and Akimentioning

confidence: 99%

AKI Associated with Macroscopic Glomerular Hematuria

Moreno

Martín-Cleary

Gutiérrez

et al. 2012

Clinical Journal of the American Society of Nephrology

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116

110

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SummaryHematuria is a common finding in various glomerular diseases. This article reviews the clinical data on glomerular hematuria and kidney injury, as well as the pathophysiology of hematuria-associated renal damage. Although glomerular hematuria has been considered a clinical manifestation of glomerular diseases without real consequences on renal function and long-term prognosis, many studies performed have shown a relationship between macroscopic glomerular hematuria and AKI and have suggested that macroscopic hematuria-associated AKI is related to adverse long-term outcomes. Thus, up to 25% of patients with macroscopic hematuriaassociated AKI do not recover baseline renal function. Oral anticoagulation has been associated with glomerular macrohematuria-related kidney injury. Several pathophysiologic mechanisms may account for the tubular injury found on renal biopsy specimens. Mechanical obstruction by red blood cell casts was thought to play a role. More recent evidence points to cytotoxic effects of oxidative stress induced by hemoglobin, heme, or iron released from red blood cells. These mechanisms of injury may be shared with hemoglobinuria or myoglobinuria-induced AKI. Heme oxygenase catalyzes the conversion of heme to biliverdin and is protective in animal models of heme toxicity. CD163, the recently identified scavenger receptor for extracellular hemoglobin, promotes the activation of anti-inflammatory pathways, opening the gates for novel therapeutic approaches.

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Factors That Determine an Incomplete Recovery of Renal Function in Macrohematuria-Induced Acute Renal Failure of IgA Nephropathy

Cited by 85 publications

References 12 publications

A case of (double) ANCA-negative granulomatosis with polyangiitis (Wegener’s)

A case of (double) ANCA-negative granulomatosis with polyangiitis (Wegener’s)

Atypical triad of IgA nephropathy: reversible acute kidney injury, gross hematuria, and severe bilateral flank pain

AKI Associated with Macroscopic Glomerular Hematuria

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