The role of the tubulointerstitial changes in the prognosis of IgA glomerulonephritis

Nagy, Judit; Trinn, C; Deák, Gy.; Schmelzer, Marilee; Burgér, T

doi:10.1007/bf01711380

Cited by 13 publications

(4 citation statements)

References 13 publications

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“…Several studies have shown that fibrosis on biopsy is an index of functional renal impairment and a major determinant in the progression of chronic kidney disease [1,5,6,10-12,17]. Our findings emphasize that although fibrosis performs well overall, it is of less value for a subset of individual cases.…”

Section: Discussionmentioning

confidence: 50%

Renal Interstitial Fibrosis: An Imperfect Predictor of Kidney Disease Progression in Some Patient Cohorts

Menn-Josephy

Lee²,

Nolin³

et al. 2016

Am J Nephrol

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Background: The extent of interstitial fibrosis on kidney biopsy is regarded as a prognostic indicator and guide to treatment. Patients with extensive fibrosis are assigned to supportive treatments with the expectation that they have advanced beyond the point at which immunosuppressive or other disease-modifying therapies would be of benefit. Our study highlights some of the limitations of using interstitial fibrosis to predict who will develop end-stage renal disease (ESRD). Methods: Analysis of 434 consecutive renal biopsies performed between 2001 and 2012 at a single center. We assessed the influence of various clinical factors along with fibrosis as predictors of ESRD and dialysis-free survival in various patient groups. Results: Interstitial fibrosis performed well overall as a predictor of progression to dialysis. On average, patients with >50% fibrosis progressed more rapidly than those with either 25-49 or 0-24% fibrosis with a median time to dialysis of 1.2, 6.5 and >10 years, respectively. In contrast, interstitial fibrosis was of less value as a predictor of disease progression in a subset of cases that included patients over the age of 70 and those with diabetic nephropathy on biopsy. Surprisingly, 13.9% of patients with normal renal function had 25-49% fibrosis and 5% had more than 50% fibrosis on biopsy, and 5 years after undergoing biopsy 21% of patients with >50% fibrosis still remained dialysis free. Conclusion: Renal fibrosis is an imperfect prognostic indicator for the development of ESRD and caution should be exercised in applying it too rigidly, especially in elderly or diabetic patients.

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Section: Discussionmentioning

confidence: 50%

Renal Interstitial Fibrosis: An Imperfect Predictor of Kidney Disease Progression in Some Patient Cohorts

Menn-Josephy

Lee²,

Nolin³

et al. 2016

Am J Nephrol

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“…For example, the clinical course of these patients was not uniform, i.e., some patients required chronic dialysis within 5-10 yr after onset, and the renal function of others slowly progressed to renal failure over a period of 20 yr after onset of the first symptoms. Variable histologic findings were also observed in the patients with progressive IgA nephropathy (42,45,46 In many chronic renal diseases, administration of an ACE inhibitor leads to a significant attenuation of proteinuria (16,49,50). Interestingly, it has been recently reported (51) that, in patients with insulin-dependent diabetes with normal renal function, the absence of the D polymorphism decreases the probability of development of microalbuminuria or proteinuria, but a strong correlation was not demonstrated in another study (52).…”

Section: Resultsmentioning

confidence: 99%

Role of the deletion of polymorphism of the angiotensin converting enzyme gene in the progression and therapeutic responsiveness of IgA nephropathy.

Yoshida¹,

Mitarai²,

Kawamura³

et al. 1995

J. Clin. Invest.

305

165

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“…More often, glomerular lesions progress because of the destruction of glomeruli by crescents and/or by focal and segmental hyalinosis and sclerosis2. On the other hand, tubulointerstitial changes have been considered to play a role in the outcome of IgAN3, but the correlation between interstitial injury and declining kidney function has been vague. Recently, Cohen et al .…”

Section: Introductionmentioning

confidence: 99%

Glomerulo‐tubular junction stenosis as a factor contributing to glomerular obsolescence in IgA nephropathy

Sato

Hasegawa

Taguma

2002

The Journal of Pathology

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Periglomerular fibrosis (PF) is an interstitial injury observed in various renal diseases. It is speculated that this lesion, by occluding the glomerulo-tubular junction (GTJ) and causing atubular glomeruli, may result functionally in a reduction of the glomerular filtration rate (GFR) and may be a factor contributing to the progression of renal disease. In the present study, 340 renal biopsy specimens were analysed to determine whether or not there was nephron injury derived from such a mechanism, as well as direct glomerular injury, in IgA nephropathy (IgAN). The patients were divided into five groups according to the degree of glomerular sclerosis. The average age was lower in groups with milder sclerosis and serum creatinine (Cr) was elevated in groups with more severe sclerosis. Because the GTJ was assumed to disappear when an atubular glomerulus was formed, the ratio of the number of glomeruli with discernible GTJ to the total number of glomeruli was evaluated. As glomerular sclerosis progressed, discernible GTJ reduced significantly (p <0.001) and the degree of PF increased significantly (p <0.05). By serial section study in cases with pronounced PF, transitions between the stages of stenosis of the GTJ and atubular glomeruli were observed. It is speculated that the occlusion of the GTJ eventually hyalinizes the glomerulus; in such cases, glomerular obsolescence of the collapse type might be formed. On the other hand, obsolescence of the mesangial proliferative type might be formed in the hyalinization derived from direct glomerular injury. In this context, glomerular obsolescence of the collapse type was observed more frequently and was accompanied by more increased PF than obsolescence of the mesangial proliferative type (p <0.001). These results suggest that in addition to direct glomerular injury, nephron injury derived from interstitial damage of this type plays an important contributory role in the progression of IgAN.

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The role of the tubulointerstitial changes in the prognosis of IgA glomerulonephritis

Cited by 13 publications

References 13 publications

Renal Interstitial Fibrosis: An Imperfect Predictor of Kidney Disease Progression in Some Patient Cohorts

Renal Interstitial Fibrosis: An Imperfect Predictor of Kidney Disease Progression in Some Patient Cohorts

Role of the deletion of polymorphism of the angiotensin converting enzyme gene in the progression and therapeutic responsiveness of IgA nephropathy.

Glomerulo‐tubular junction stenosis as a factor contributing to glomerular obsolescence in IgA nephropathy

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