Presentation, prognosis and outcome of IgA nephropathy in Indian adults

Abstract

The relatively rapid rate of progression of IgAN in India is suggestive towards a 'malignant' nature of the disease in this country.

IgA Nephropathy in India: What We Do Know

“…Nephrotic syndrome (55%), renal failure (serum creatinine > 1.4 mg/dL in 60%), hypertension (58%), and acute nephritis (16%) were the commonest modes of presentation. 24 Clinical features that were unusually severe in a high proportion were also found in other studies from India (Table 1). Restrictive biopsy policies with consequent "selection" of the population whose clinical course is closely monitored might explain this variation in the modes of presentation.…”

“…26 The same has been used in the two studies concentrating on histology. The Vellore group 24 reported a higher frequency of class III (focal proliferative GN, 50%), followed by class II (focal and segmental glomerulosclerosis without active cellular proliferation, 25%), class IV (diffuse proliferative of GN, 15%), and class V (≥40% globally sclerotic glomeruli and/or ≥40% tubular atrophy or loss, 10%).…”

“…To avoid bias, factors associated with progression were analyzed separately for groups defined on the basis of level of renal function at diagnosis. In this study, 24 only the existence and the degree of hypertension and impaired creatinine clearance at the time of diagnosis were associated with progression at all stages of the disease on the biopsy that were defined and studied. Higher levels of proteinuria, serum triglyceride, and serum uric acid were statistically associated with progression in patients with renal insufficiency at presentation.…”

“…Nevertheless, this model assumes that the effect of each risk factor remains constant with time, and we do not know whether it is true for IgAN. From the analysis of our cohort 24 of patients, Cox's regression model allowed us to find four significant risk factors for the development of ESRD and gave for each of them their relative weight (b-coefficient). In addition to this, we can estimate the probability of renal survival with the following equation:…”

Clinical and histopathologic profile of patients with primary IgA nephropathy seen in a tertiary hospital in India

“…6 The prevalence of IgAN in India 7-10 is reported to be 4.5-16% of all patients with biopsy verified glomerular disease, and it is considered to be a severe disease with poor outcome. 7 Nephrotic range proteinuria (NRP) is uncommon with IgAN in Whites as well as Asians with an incidence of 5-30%.…”