Prognosis in IgA Nephropathy: 30-Year Analysis of 1,012 Patients at a Single Center in Japan

Abstract

BackgroundLittle is known about the long-term prognosis of patients with IgA nephropathy (IgAN).MethodsThis retrospective cohort analysis evaluated clinical and histological findings at the time of renal biopsy, initial treatment, patient outcomes over 30 years, and risk factors associated with progression in 1,012 patients diagnosed with IgAN at our center since 1974.ResultsOf the 1,012 patients, 40.5% were male. Mean patient age was 33±12 years and mean blood pressure was 122±17/75±13 mmHg. Mean serum creatinine concentration was 0.89±0.42 mg/dL, and mean estimated glomerular filtration rate (eGFR) was 78.5±26.2 ml/min/1.73 m2. Mean proteinuria was 1.19±1.61 g/day, and mean urinary red blood cells were 36.6±35.3/high-powered field. Histologically, mesangial hypercellularity was present in 47.6% of patients, endothelial hypercellularity in 44.3%, segmental sclerosis in 74.6%, and tubular atrophy/interstitial fibrosis in 28.8% by Oxford classification. Initial treatment consisted of corticosteroids in 26.9% of patients, renin-angiotensin-aldosterone system inhibitor in 28.9%, and tonsillectomy plus steroids in 11.7%. The 10-, 20-, and 30-year renal survival rates were 84.3, 66.6, and 50.3%, respectively. Tonsillectomy plus steroids dramatically improved renal outcome. Cox multivariate regression analysis showed that higher proteinuria, lower eGFR, and higher uric acid at the time of renal biopsy were independent risk factors for the development of end stage renal disease (ESRD).ConclusionsIgAN is not a benign disease, with about 50% of patients progressing to ESRD within 30 years despite treatment.

The efficacy of tonsillectomy on clinical remission and relapse in patients with IgA nephropathy: a randomized controlled trial

“…IgAN is not a benign disease; according to a retrospective cohort analysis evaluated clinical and histological findings in 1012 patients diagnosed with IgAN, with about 50% of patients progressing to ESRD within 30 years despite treatment, this study also shown that tonsillectomy plus steroids dramatically improved renal outcome. 17 Although the recent Kidney Disease:…”

Corticosteroids in IgA Nephropathy

“…Proteinuria decreased by a median of 0.5 g/24h during follow-up. Overall, the median number of creatinine, proteinuria, and blood pressure measurements was 5 (3)(4)(5)(6)(7)(8), 4 (3-7), and 5 (3)(4)(5)(6)(7)(8), respectively.…”

Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group

“…Sixteen such studies [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] , including cohorts from Europe, North America, and East Asia were meta-analysed in a report published in 2013 21 . Lately, more studies have been published including cohorts from Iran, Europe, Japan and Korea [22][23][24][25][26][27][28] . All these studies are summarised in Supplementary Table 1.…”