Heterogeneity of Prognosis in Adult IgA Nephropathy, Especially with Mild Proteinuria or Mild Histological Features.

Abstract

Objective The present study was undertaken to clarify the clinical course and prognosis of adult patients with primary IgA nephropathy (IgAN), especially with mild pro-teinuria or mild histological alternations. Patients and Methods A population of 735 IgAN patients whomwe were able to observe for morethan two years was examined. Results A total of 115 patients (15.6%) was on dialysis during the observation period. The overall 5-year renal survival rate was 92.0%. On the other hand, 166 patients (22.6%) were in clinical remission. A group with mild pro-teinuria included 197 patients (26.8 %). Forty-seven patients of this group showedminor glomerular abnormalities, whereas 12 patients with mild proteinuria showed severe mesangial involvement. Three patients with mild pro-teinuria were on dialysis during the observation period, whose proteinuria was increased during the clinical course. A group with minor glomerular abnormalities included 82 patients (1 1.2 %). Forty-seven patients of this group showed mild proteinuria, of whom12 patients showed moderate proteinuria. However, three patients with minor glomeru-lar abnormalities who were not on dialysis showed loss of renal function. Conclusion These results indicated the heterogeneity of the course and prognosis in IgAN. Even if a patient's initial clinical or histological findings are comparatively mild, strict follow-up management is needed. (Internal Medicine 40: 697-702, 2001)

Impact of Hypertension and Hypertension-Related Vascular Lesions in IgA Nephropathy

“…These studies included a relatively large number of patients with hypertension or renal insufficiency at biopsy, which was not the case in the aforementioned studies (7,8). In Usui's study (21), renal histopathology showed severe mesangial involvement or glomerular sclerosis in 6.1% of 197 patients. In Szeto's study (6), severe renal injury was observed in 12.5% of 72 patients.…”

“…Recently, however, two studies on IgAN with mild proteinuria have shown contradictory results (6,21). These studies included a relatively large number of patients with hypertension or renal insufficiency at biopsy, which was not the case in the aforementioned studies (7,8).…”

“…Therefore, we can exclude the possibil-ity that glomerular sclerosis is not solely related to aging. Thus far, it has been reported that in IgAN, age at onset or biopsy is well correlated with proteinuria (21,27), renal function (19,27,28), blood pressure (19,27,28), histopathological changes (6,19,28), and poor prognosis (19,28). Although age at biopsy was not selected as an independent risk factor for arteriosclerosis, we do not exclude the possibility that age affects the prognosis in IgAN.…”

Chronic kidney disease perspectives in Japan and the importance of urinalysis screening

“…For early detection of glomerulonephritis, urinalysis has been considered one of the best methods [35,36]. The level of proteinuria is one of the strongest predictors for renal function deterioration [24,[37][38][39][40][41]. Consequently, to prevent an increase in the number of ESRD patients in Japan, a dipstick urine examination has been continued under the auspices of local governments and the Ministry of Health, Labor and Welfare of Japan since 1972 [23,24].…”

The Prognosis of IgA Nephropathy-Favorable or Poor ?-

“…In this paper, it was the most attractive low, but those percentages cannot be disregarded in daily clinical treatment.The most important point is how do we find these patients with unexpected-prognosis and prevent the decline of renal function of those patients. Usui et al (24) …”