Stratifying risk for progression in IgA nephropathy: how to predict the future?

Rafalska, Agnieszka; Franczuk, Jolanta; Franczuk, Paweł; Augustyniak−Bartosik, Hanna; Krajewska, Magdalena

doi:10.20452/pamw.2341

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…25) Hematuria is also a marker which identifies IgAN patients at high risk of progression. 26,27) In our study, the rates of hematuria in the CTW and DTW groups were higher than that of the PRE group.…”

Section: Discussioncontrasting

confidence: 43%

Effects of <i>Tripterygium wilfordii</i> Induction Therapy to IgA Nephropathy Patients with Heavy Proteinuria

Wang

Zhou

et al. 2017

Biological & Pharmaceutical Bulletin

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and DTW groups (87.5%) achieved complete remission; none of the CTW group did. Furthermore, the total remission rate of the DTW group was substantially higher than that of the CTW group. The degree of hypoproteinemia, improved considerably in the PRE and DTW groups. Treatment was well tolerated in all patients, and no serious adverse events were observed. Our findings suggested that induction therapy with double dose TWHF significantly improved response rates in IgAN patients with heavy proteinuria, and did not considerably increase side effects.

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Section: Discussioncontrasting

confidence: 43%

Effects of <i>Tripterygium wilfordii</i> Induction Therapy to IgA Nephropathy Patients with Heavy Proteinuria

Wang

Zhou

et al. 2017

Biological & Pharmaceutical Bulletin

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“…This classification has been validated in numerous studies with different ethnic populations [7, 10–14, 16, 18, 28]. However, the predictive value of crescent lesions for worse kidney survival was not determined mostly due to the low prevalence of crescents in included patients and the lack of end point events [6].…”

Section: Discussionmentioning

confidence: 99%

“…In this meta-analysis, we were unable to perform a subgroup analysis to explore the predictive significance of mild, moderate or severe crescent formation in IgAN respectively. It was because only 5 of the 20 included studies [10, 12, 16–18] had the exact definitions of C1 according to the percentage of glomeruli with crescent lesions, and the definitions were inconsistent among these studies. The JHC 2013 of IgAN confirmed crescent formation as the predictive marker of ESKD and developed four histological grades (HGs) established corresponding to the percentage of glomeruli exhibiting cellular or fibrocellular crescents, global sclerosis, segmental sclerosis or fibrous crescents, respectively [19], but we were unable to determine the precise proportion of crescent lesions in each grade.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of crescent formation as a predictive marker in immunoglobulin A nephropathy: a systematic review and meta-analysis

Shao

Cao

et al. 2017

Oncotarget

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The 2009 Oxford Classification of immunoglobulin A (IgA) nephropathy (IgAN) identifies four histological features as predictors of renal prognosis: mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T). However, the clinical and prognostic significance of crescent formation still remains controversial. Therefore, we performed a meta-analysis to evaluate the association between crescents and kidney outcome in IgAN. A total of 20 studies published from January 2009 to July 2016 involving 5,285 patients were included after systematic searches of PubMed and EMBASE databases. Pooled results showed that crescent lesions were associated with kidney failure (HR, 1.93; 95% CI, 1.49-2.50; P < 0.001). IgAN patients with crescents had lower eGFR levels (SMD, -0.21; 95% CI, -0.40--0.03; P = 0.023); higher proteinuria levels (SMD, 0.87; 95% CI, 0.11-1.63; P = 0.024); a larger number of patients with M1 (RR, 1.22; 95% CI, 1.07-1.40; P = 0.003), E1 (RR, 4.83; 95% CI, 3.04-7.66;P < 0.001), S1 (RR, 1.76; 95% CI, 1.11-2.80; P = 0.016) and T1/2 (RR, 2.74; 95% CI, 2.10-3.57; P < 0.001) lesions; and received immunosuppressive therapy more frequently (RD, 0.17; 95% CI, 0.11-0.23; P < 0.001). Our results suggest that crescent formation represents an efficient prognostic factor associated with progression to kidney failure and thus could be considered into the new Oxford Classification.

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“…An impaired glomerular filtration rate (GFR), sustained hypertension and substantial proteinuria independently predict a poor clinical course in IgAN 4 , 8 . Due to the lack of a disease-targeted treatment, control of proteinuria and blood pressure is emphasized by both the KDIGO and KDOQI guidelines.…”

Section: Introductionmentioning

confidence: 99%

The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China

Huan¹,

Luo²,

Wang³

et al. 2016

Clinics

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OBJECTIVE:This study investigated the correlation between the albumin-to-creatinine ratio in the urine and 24-hour urine proteinuria and whether the ratio can predict chronic kidney disease progression even more reliably than 24-hour proteinuria can, particularly in primary IgA nephropathy.METHODS:A total of 182 patients with primary IgA nephropathy were evaluated. Their mean urine albumin-to-creatinine ratio and 24-hour proteinuria were determined during hospitalization. Blood samples were also analyzed. Follow-up data were recorded for 44 patients. A cross-sectional study was then conducted to test the correlation between these parameters and their associations with chronic kidney disease complications. Subsequently, a canonical correlation analysis was employed to assess the correlation between baseline proteinuria and parameters of the Oxford classification. Finally, a prospective observational study was performed to evaluate the association between proteinuria and clinical outcomes. Our study is registered in the Chinese Clinical Trial Registry, and the registration number is ChiCTR-OCH-14005137.RESULTS:A strong correlation (r=0.81, p<0.001) was found between the ratio and 24-hour proteinuria except in chronic kidney disease stage 5. First-morning urine albumin-to-creatinine ratios of ≥125.15, 154.44 and 760.31 mg/g reliably predicted equivalent 24-hour proteinuria ‘thresholds’ of ≥0.15, 0.3 and 1.0 g/24 h, respectively. In continuous analyses, the albumin-to-creatinine ratio was significantly associated with anemia, acidosis, hypoalbuminemia, hyperphosphatemia, hyperkalemia, hypercholesterolemia and higher serum cystatin C. However, higher 24-hour proteinuria was only associated with hypoalbuminemia and hypercholesterolemia. Higher tubular atrophy and interstitial fibrosis scores were also associated with a greater albumin-to-creatinine ratio, as observed in the canonical correlation analysis. Finally, the albumin-to-creatinine ratio and 24-hour proteinuria were associated with renal outcomes in univariate analyses.CONCLUSION:This study supports the recommendation of using the albumin-to-creatinine ratio, rather than 24-hour proteinuria, to monitor proteinuria and prognosis in primary IgA nephropathy.

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Stratifying risk for progression in IgA nephropathy: how to predict the future?

Cited by 5 publications

References 13 publications

Effects of <i>Tripterygium wilfordii</i> Induction Therapy to IgA Nephropathy Patients with Heavy Proteinuria

Effects of <i>Tripterygium wilfordii</i> Induction Therapy to IgA Nephropathy Patients with Heavy Proteinuria

Evaluation of crescent formation as a predictive marker in immunoglobulin A nephropathy: a systematic review and meta-analysis

The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China

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