Remission of Proteinuria Improves Prognosis in IgA Nephropathy

Reich, Heather N.; Troyanov, Stéphan; Scholey, James W.; Cattran, Daniel C.

doi:10.1681/asn.2007050526

Cited by 480 publications

(412 citation statements)

References 43 publications

Supporting

Mentioning

392

Contrasting

Unclassified

Order By: Relevance

“…IgA nephropathy (IgAN) is the most common form of GN worldwide, comprising 45% of all primary GN cases (1,2). Many studies report that 30%-40% of patients with IgAN reach ESRD within 20 years from apparent disease onset, underscoring that IgAN is not a benign condition (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Clinical Features and Outcomes of IgA Nephropathy with Nephrotic Syndrome

Kim¹,

Kim²,

Lee

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Summary Background and objectives Nephrotic syndrome (NS) is a rare manifestation of IgA nephropathy (IgAN). Clinical characteristics and long-term outcomes of this condition have not yet been explored. Design, setting, participants, & measurements A multicenter observational study was conducted between January 2000 and September 2010 in 1076 patients with biopsy-proven IgAN from four medical centers in Korea. The primary outcome was a doubling of the baseline serum creatinine concentration. Results Of the 1076 patients, 100 (10.2%) presented with NS; complete remission (CR), partial remission (PR), and no response (NR) occurred in 48 (48%), 32 (32%), and 20 (20%) patients, respectively. During the median follow-up of 45.2 months, 24 patients (24%) in the NS group reached the primary endpoint compared with 63 (7.1%) in the non-NS group (P<0.001). The risk of reaching the primary endpoint was significantly higher in the PR (P=0.04) and NR groups (P<0.001) than in the CR group. Among patients with NS, 24 (24%) underwent spontaneous remission (SR). SR occurred more frequently in female patients and in patients with serum creatinine levels ≤1.2 mg/dl and a >50% decrease in proteinuria within 3 months after NS onset. None of the patients with SR reached the primary endpoint and they had fewer relapses during follow-up. Conclusions This study demonstrated that the prognosis of NS in IgAN was not favorable unless PR or CR was achieved. In addition, SR was more common than expected, particularly in patients with preserved kidney function and spontaneous decrease in proteinuria shortly after NS onset.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical Features and Outcomes of IgA Nephropathy with Nephrotic Syndrome

Kim¹,

Kim²,

Lee

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Although the clinical presentation and course of IgA nephropathy is quite variable, ranging from asymptomatic microscopic hematuria to rapidly progressive glomerulonephritis, IgA nephropathy progresses insidiously and 10-30% of patients reach end-stage renal disease within 20 years. [2][3][4][5][6][7] Recent studies have revealed that the pathogenesis of IgA nephropathy involves an autoimmune response with the formation of abnormally glycosylated IgA1. Lymphocytes from patients with IgA nephropathy produce IgG that form immune complexes with abnormally glycosylated IgA1.…”

mentioning

confidence: 99%

Glomerular IgG deposition predicts renal outcome in patients with IgA nephropathy

et al. 2016

View full text Add to dashboard Cite

Glomerular IgG deposition is frequently observed in patients with IgA nephropathy. However, the association between glomerular IgG deposition and progression of IgA nephropathy is uncertain. Six hundred and twentyseven patients with biopsy-proven IgA nephropathy were recruited. Histological variables of the Oxford classification (Oxford-MEST) and the presence of glomerular IgG deposits were assessed. Renal progression defined as end-stage renal disease or 50% reduction in estimated glomerular filtration rate was analyzed using Kaplan-Meier methods and Cox regression analysis. Of the study population, 200 patients (31.9%) had glomerular IgG deposition on immunofluorescence staining. During a mean follow-up of 56.8 ± 37.5 months, the rate of renal progression was significantly higher in the IgA nephropathy patients with glomerular IgG deposition compared with the IgA nephropathy patients without glomerular IgG deposition (39.8 vs 12.3 per 1000 patientyears; Po 0.001). Of patients with IgG deposition, 178 (28.3%), 20 (3.2%), and 2 (0.3%) patients had mild, moderate, and marked glomerular IgG deposits, receptively. Kaplan-Meier analysis revealed that cumulative renal survival was significantly lower in IgA nephropathy patients with the higher intensity of glomerular IgG deposits (Po 0.001). In addition, Cox regression analysis revealed that moderate and marked glomerular IgG deposits significantly predicted renal outcome independent of Oxford-MEST and clinical variables (HR, 2.97; 95% CI, 1.01-8.77; P = 0.04). This study showed that that glomerular IgG deposition was independently associated with poor renal outcome in patient with IgA nephropathy.

show abstract

“…A difference in the incidence of macroscopic hematuria in adult patients was found when compared between various geographical regions 18. In European countries, the reported incidence exceeded 50%;1920 whereas in Japan, the incidence ranged from 15% to 31% 2122. This difference in distribution can be attributed to the difference in the nature of the disease, which could be linked to genetic factors 19.…”

Section: Discussionmentioning

confidence: 94%

Clinical and histopathological spectrum of IgA nephropathy in Kuwait

Ghani

Waheeb

Homoud

et al. 2011

Annals of Saudi Medicine

View full text Add to dashboard Cite

BACKGROUND:Little is known about the nature and the course of IgA nephropathy (IgAN) in Arab countries. The aim of this work was to study the spectrum of clinical presentation and histopathological findings at our institution.DESIGN AND SETTING:Retrospective review, all renal biopsies at the Mubarak Al Kabeer Hospital between January 2000 and December 2004.METHODS:Cases of IgA nephropathy were selected, and their medical records and biopsy findings were reviewed.RESULTS:Eighty patients (9.2% of all native kidney biopsies) were diagnosed to have IgAN nephropathy. Sixty-nine biopsies were included in the study;11 were excluded. Forty-three (62.3%) patients were male and 26 (37.7) patients were female. Fifty (72.5%) patients were below the age of 40 years. Mean (SD) duration of follow-up was 3.6 (1.3) years. The first presentation included nephritic-range proteinuria (49.3%) and renal impairment (50.7%). During the follow-up period, 56 (81.2%) patients were stable or improved. Hass classification of biopsies showed 36.2% had class I, 27.5% had class II, 13.0% had class III, 5.8% had class IV, and 17.4% had class V IgAN. Females had milder forms of the disease than males. Macroscopic hematuria and renal impairment at presentation were seen more in patients with class IV and V IgAN. The presenting serum creatinine and uric acid values were higher in those with Hass classes III to V. Deterioration of renal function during the follow-up period was more significant in the presence of hypertension, renal impairment, or macroscopic hematuria at the time of biopsy .CONCLUSION:The prevalence of IgAN in Kuwait is about 9.2%. Renal impairment or macroscopic hematuria at presentation was seen in patients with more aggressive renal lesions and contributed to poor outcome.

show abstract

Remission of Proteinuria Improves Prognosis in IgA Nephropathy

Cited by 480 publications

References 43 publications

Clinical Features and Outcomes of IgA Nephropathy with Nephrotic Syndrome

Clinical Features and Outcomes of IgA Nephropathy with Nephrotic Syndrome

Glomerular IgG deposition predicts renal outcome in patients with IgA nephropathy

Clinical and histopathological spectrum of IgA nephropathy in Kuwait

Contact Info

Product

Resources

About