Idiopathic IgA Mesangial Nephropathy

DʼAMICO, GIUSEPPE; Imbasciati, E; Belgioioso, G. Barbiano Di; Bertoli, Silvio; FOGAZZI, GIOVAMBATTISTA; Ferrario, Franco; Fellin, G; Ragni, A.; Colasanti, G.; Minetti, L; Ponticelli, Claudio

doi:10.1097/00005792-198501000-00004

Cited by 184 publications

(49 citation statements)

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“…Although proteinuria is a known risk factor for progression of IgAN, [2][3][4][5][6]8,9,14,28 important questions regarding its role in the prognosis of IgAN remain. First, timing of measurement requires clarification; proteinuria at diagnosis often is not a predictor of outcome by multivariate analysis, 2,17 whereas proteinuria at 1 yr or later may better indicate prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Although many studies have found a relationship between sclerosis/fibrosis and outcome, these studies did not include sequential measurements of MAP/proteinuria over time 5,44,45 or had shorter follow-up. 3 Indeed, a relationship between biopsy class and final follow-up data has been noted 15 ; however, the value of adding the pathologic information to repeated sequential clinical measurements over time has not been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

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Remission of Proteinuria Improves Prognosis in IgA Nephropathy

Reich

Troyanov²,

Scholey³

et al. 2007

Journal of the American Society of Nephrology

495

413

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Proteinuria has been shown to be an adverse prognostic factor in IgA nephropathy. The benefit of achieving a partial remission of proteinuria, however, has not been well described. We studied 542 patients with biopsy-proven primary IgA nephropathy in the Toronto Glomerulonephritis Registry and found that glomerular filtration rate (GFR) declined at Ϫ0.38 Ϯ 0.61 ml/min per 1.73 m 2 /mo overall, with 30% of subjects reaching end-stage renal disease. Multivariate analysis revealed that proteinuria during follow-up was the most important predictor of the rate of GFR decline. Among the 171 patients with Ͻ1 g/d of sustained proteinuria, the rate of decline was 90% slower than the mean rate. The rate of decline increased with the amount of proteinuria, such that those with sustained proteinuria Ͼ3 g/d (n ϭ 121) lost renal function 25-fold faster than those with Ͻ1 g/d. Patients who presented with Ն3 g/d who achieved a partial remission (Ͻ1 g/d) had a similar course to patients who had Յ1 g/d throughout, and fared far better than patients who never achieved remission. These results underscore the relationship between proteinuria and prognosis in IgA nephropathy and establish the importance of remission.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Remission of Proteinuria Improves Prognosis in IgA Nephropathy

Reich

Troyanov²,

Scholey³

et al. 2007

Journal of the American Society of Nephrology

495

413

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“…In this respect, HSP nephropathy may resemble IgA nephropathy. Many authors indeed had initially reported a favorable outcome for IgA nephropathy until the point in time when follow-up was long enough to enable them to conclude that end-stage renal disease was a frequent complication (31)(32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Henoch-Scho[Combining Diaeresis]nlein Purpura in Adults

Pillebout¹,

Thervet²,

Hill³

et al. 2002

Journal of the American Society of Nephrology

490

439

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Abstract. Henoch-Schönlein Purpura nephritis (HSPN) has been extensively studied in children but, its natural history in adults is much less known. A cohort of 250 adults suffering HSP was retrospectively analyzed for a median follow-up period of 14.8 yr. All patients had biopsies consistent with HSP (predominant IgA mesangial deposits) associated with purpura, bowel angina, and/or abdominal pain. At presentation, palpable purpura was present in 96% of patients, and arthritis was reported in 61%, and gastrointestinal involvement in 48%. Thirty-two percent of the patients showed renal insufficiency (Creatinine clearance [CrCl] Ͻ50 ml/min), usually associated with proteinuria (99%) and/or hematuria (93%). Endocapillary glomerulonephritis was the most frequent lesion on renal biopsy (61%). At the end of follow-up, patient survival was only 74%. The first cause of death was carcinoma (most of them of respiratory or digestive tract). Regarding renal function, 11% of patients reached end-stage renal failure, 13% exhibited severe renal failure (CrCl Ͻ30 ml/min), and 14% moderate renal insufficiency (CrCl Ͻ50 ml/min). Clinical remission defined as the absence of proteinuria, hematuria, and a normal renal function was achieved in only 20%. This is a retrospective study; therefore, it is not possible to demonstrate any steroid and/or cyclophosphamide efficacy in diminishing the incidence of renal insufficiency. Multivariate analysis demonstrated that renal function impairment and proteinuria level at presentation and, on renal biopsy, the degree of interstitial fibrosis, percentage of sclerotic glomeruli, and presence of glomeruli with fibrinoid necrosis were associated with a poor renal prognosis. The data indicate that clinical presentation of HSPN in adults is severe and its outcome relatively poor, worse than in children. Identification of clinical and histologic prognostic factors may permit the design of appropriate therapeutic prospective studies.Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis involving small vessels with the deposition of immune complexes containing IgA. It is characterized by the association of skin, joint, and gastrointestinal manifestations that may occur in successive episodes (1). In addition to these manifestations, renal involvement is common, and the long-term prognosis depends on its severity.HSP primarily affects children, and its incidence is approximately 15 cases/100,000 children per yr (2); it is less common in adults. Although HSP has been extensively studied in children, much less is known about its natural history in adults. Apart from a recent multicenter Italian study (3,4), data on this disease in adults are confined to small series with relatively short follow-up (5-15). In adults, however, the incidence of HSP and the severity of its clinical manifestations appear not to be the same as in children.The incidence of renal involvement in adults varies from 45 to 85% of cases, depending on the data for patients and the definition of renal involvement (16). Among c...

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“…IgA nephropathy, the most common glomerulonephritis worldwide, is an important cause of end-stage renal disease (1). Although the factors responsible for progressive renal failure in this disease have not been fully elucidated, systemic hypertension and increased urinary protein excretion are clinical predictors of poor outcome (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…Although the factors responsible for progressive renal failure in this disease have not been fully elucidated, systemic hypertension and increased urinary protein excretion are clinical predictors of poor outcome (1,2). Recent studies on IgA nephropathy have demonstrated intrarenal angiotensin II hyperreactivity in patients with progressive disease (3), while treatment with angiotensin-converting enzyme (ACE) 1 inhibitors has been shown to improve glomerular permselectivity (4) and to delay progression to chronic renal failure (5,6).…”

Section: Introductionmentioning

confidence: 99%

Association of angiotensinogen gene T235 variant with progression of immunoglobin A nephropathy in Caucasian patients.

Pei¹,

Scholey²,

Thai³

et al. 1997

J. Clin. Invest.

113

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Genetic variability in the renin-angiotensin system may modify renal responses to injury and disease progression. We examined whether the M235T polymorphism of the angiotensinogen (AGT) gene, the insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) gene, and the A 1166 → C polymorphism of the angiotensin II type 1 receptor gene may be associated with disease progression in 168 Caucasian patients with IgA nephropathy. All patients had serial measurements of their creatinine clearance, proteinuria, and blood pressure (mean Ϯ SD) with a follow-up of 6.1 Ϯ 4.7 yr. The genotype frequencies for each gene were consistent with Hardy-Weinberg equilibrium, and were similar to those of 100 Caucasian control subjects. We examined two primary outcomes: ( a ) the rate of deterioration of Ccr, and ( b ) the maximal level of proteinuria. We found that patients with the AGT MT ( n ϭ 79) and TT ( n ϭ 29) genotypes had a faster rate of deterioration of Ccr than those with the MM ( n ϭ 60) genotype (i.e., median values, Ϫ 6.6 and Ϫ 6.2 vs.

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Idiopathic IgA Mesangial Nephropathy

Cited by 184 publications

References 0 publications

Remission of Proteinuria Improves Prognosis in IgA Nephropathy

Remission of Proteinuria Improves Prognosis in IgA Nephropathy

Henoch-Scho[Combining Diaeresis]nlein Purpura in Adults

Association of angiotensinogen gene T235 variant with progression of immunoglobin A nephropathy in Caucasian patients.

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