Long-Term Outcomes of IgA Nephropathy Presenting with Minimal or No Proteinuria

Abstract

The long-term outcome of patients with IgA nephropathy who present with normal renal function, microscopic hematuria, and minimal or no proteinuria is not well described. Here, we studied 141 Caucasian patients with biopsy-proven IgA nephropathy who had minor abnormalities at presentation and a median follow-up of 108 months. None of the patients received corticosteroids or immunosuppressants. We reviewed renal biopsies using the Oxford classification criteria. In this sample, 46 (32%) patients had mesangial proliferation, whereas endocapillary proliferation, focal glomerulosclerosis, and tubulointerstitial abnormalities were uncommon. Serum creatinine increases .50% and .100% were observed in five (3.5%) patients and one (0.7%) patient, respectively; no patients developed ESRD. After 10, 15, and 20 years, 96.7%, 91.9%, and 91.9% of patients maintained serum creatinine values less than a 50% increase, respectively. Using Cox proportional hazards regression, the presence of segmental glomerulosclerosis was the only factor that significantly associated with a .50% increase in serum creatinine. Clinical remission occurred in 53 (37.5%) patients after a median of 48 months. Proteinuria.0.5 and .1.0 g/24 h developed in 21 (14.9%) and 6 (4.2%) patients, respectively. Median proteinuria at the end of follow-up was 0.1 g/24 h, with 41 (29.1%) patients having no proteinuria. At presentation, 23 (16.3%) patients were hypertensive compared with 30 (21.3%) patients at the end of follow-up; 59 (41.8%) patients were treated with reninangiotensin blockers because of hypertension or increasing proteinuria. In summary, the long-term prognosis for Caucasian patients with IgA nephropathy who present with minor urinary abnormalities and normal renal function is excellent.

Association of C4d Deposition with Clinical Outcomes in IgA Nephropathy

“…It is characterized by a highly variable course ranging from a totally benign condition (2) to ESRD (3,4).…”

Mycophenolate mofetil therapy in immunoglobulin A nephropathy: histological changes after treatment

“…Heavy proteinuria, hypertension and impaired renal function at the time of diagnosis are wellestablished clinical risk factors for the progression of IgAN [21][22][23][24]. The Oxford Classification of IgAN also identified four histological lesions associated with poor outcome: mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis and tubular atrophy/ interstitial fibrosis [1].…”

Hematuria is a risk factor towards end-stage renal disease - A propensity score analysis

“…Most recently, Lin et al showed that microscopic hematuria was associated with increased risk of ESRD in 1,799 patients with stage 3 to 5 nondiabetic CKD. Whereas, there are several reports denying microscopic hematuria as a risk factor of CKD progression in patients with IgA nephropathy [5,6] …”

“…Recently, it has been suggested that young persons with persistent isolated microscopic hematuria may indeed have an increased risk for ESRD as compared with individuals without this condition [4]. On the other hand, there are several contradictory results, ruling out the impact of microscopic hematuria on the outcome of IgA nephropathy [5,6]. Therefore, microscopic hematuria has not reached consensus as a risk factor of ESRD [7].…”