Long-term prognosis of clinically early IgA nephropathy is not always favorable

Hajeong Lee, Jin Ho Hwang, Jin Ho Paik, Hyun Jin Ryu, Dong Ki Kim, Ho Jun Chin, Yun Kyu Oh, Kwon Wook Joo, Chun Soo Lim, Yon Su Kim, Jung Pyo Lee, Hajeong Lee, Jin Ho Hwang, Jin Ho Paik, Hyun Jin Ryu, Dong Ki Kim, Ho Jun Chin, Yun Kyu Oh, Kwon Wook Joo, Chun Soo Lim, Yon Su Kim, Jung Pyo Lee

Abstract

Background: The long-term prognosis of clinically early IgA nephropathy (IgAN) patients remains to be clarified. We investigated the long-term outcomes of IgAN patients with an apparently benign presentation and evaluated prognostic factors for renal survival.

Methods: We included patients with biopsy-proven IgAN who had estimated glomerular filtration rates (eGFR) ≥ 60 mL/min/1.73 m2, normal blood pressure, and proteinuria <0.5 g/day at the time of biopsy. The primary outcome was progression to end-stage renal disease (ESRD). The secondary outcome was a 50% increase in serum creatinine level or an increase in proteinuria to >1 g/day.

Results: The analysis included 153 patients who met the inclusion criteria. At diagnosis, their median systolic blood pressure was 120 (110-130) mmHg, eGFR was 85.9 (74.9-100.1) mL/min/1.73 m2, and proteinuria was 0.25 (0.13-0.38) g/day. Of these, 4 patients died and 6 reached ESRD. The 30-year renal survival rate was 85.5%. Three patients had increased serum creatinine levels and 11 developed proteinuria. Remission was observed in 35 (22.9%) patients. A moderate or severe degree of interstitial fibrosis (adjusted odd ratio [OR] 5.93, 95% confidence interval [CI] 1.44-24.45, P=0.014) and hypoalbuminemia (adjusted OR 6.18, 95% CI 1.20-31.79, P=0.029) were independent predictors of the secondary outcome.

Conclusions: This study showed that the prognosis of early IgAN was not always favorable, even resulting in progression to ESRD in some cases. Hypoalbuminemia and interstitial fibrosis should also be considered important prognostic factors in clinically early IgAN patients.

Figures

Figure 1
Figure 1
Participation flow diagram.
Figure 2
Figure 2
Cumulative renal and patient survival after kidney biopsy in early IgAN patients. The primary endpoint is free of death or end stage renal disease. The number of patients remaining at 60, 120, 180, 240, 300 and 360 months of follow–up are shown at the bottom.

References

    1. Lee H, Kim DK, Oh KH, Joo KW, Kim YS, Chae DW, Kim S, Chin HJ. Mortality and renal outcome of primary glomerulonephritis in Korea: observation in 1,943 biopsied cases. Am J Nephrol. 2013;37(1):74–83. doi: 10.1159/000345960.
    1. Barbour SJ, Reich HN. Risk stratification of patients with IgA nephropathy. Am J Kidney Dis. 2012;59(6):865–873. doi: 10.1053/j.ajkd.2012.02.326.
    1. Wyatt RJ, Julian BA. IgA nephropathy. N Engl J Med. 2013;368(25):2402–2414. doi: 10.1056/NEJMra1206793.
    1. Lee H, Kim DK, Oh KH, Joo KW, Kim YS, Chae DW, Kim S, Chin HJ. Mortality of IgA nephropathy patients: a single center experience over 30 years. PLoS One. 2012;7(12):e51225. doi: 10.1371/journal.pone.0051225.
    1. Kiryluk K, Novak J, Gharavi AG. Pathogenesis of immunoglobulin A nephropathy: recent insight from genetic studies. Annu Rev Med. 2013;64:339–356. doi: 10.1146/annurev-med-041811-142014.
    1. Gutiérrez E, Zamora I, Ballarín JA, Arce Y, Jiménez S, Quereda C, Olea T, Martínez-Ara J, Segarra A, Bernis C, García A, Goicoechea M, García de Vinuesa S, Rojas-Rivera J, Praga M. Long-term outcomes of IgA nephropathy presenting with minimal or no proteinuria. J Am Soc Nephrol. 2012;23(10):1753–1760. doi: 10.1681/ASN.2012010063.
    1. Li PK, Ho KK, Szeto CC, Yu L, Lai FM. Prognostic indicators of IgA nephropathy in the Chinese–clinical and pathological perspectives. Nephrol Dial Transplant. 2002;17(1):64–69. doi: 10.1093/ndt/17.1.64.
    1. Szeto CC, Lai FM, To KF, Wong TY, Chow KM, Choi PC, Lui SF, Li PK. The natural history of immunoglobulin a nephropathy among patients with hematuria and minimal proteinuria. Am J Med. 2001;110(6):434–437. doi: 10.1016/S0002-9343(01)00659-3.
    1. Shen P, He L, Huang D. Clinical course and prognostic factors of clinical early IgA nephropathy. Neth J Med. 2002;66(6):242–247.
    1. Knoop T, Vikse BE, Svarstad E, Leh S, Reisaeter AV, Bjorneklett R. Mortality in patients with IgA nephropathy. Am J Kidney Dis. 2013;62(5):833–890.
    1. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247–254. doi: 10.7326/0003-4819-145-4-200608150-00004.
    1. Lee CS, Cha RH, Lim YH, Kim H, Song KH, Gu N, Yu KS, Lim CS, Han JS, Kim S, Kim YS. Ethnic coefficients for glomerular filtration rate estimation by the Modification of Diet in Renal Disease study equations in the Korean population. J Korean Med Sci. 2010;25(11):1616–1625. doi: 10.3346/jkms.2010.25.11.1616.
    1. Sinniah R. IgA Mesangial Nephropathy: Berger’s Disease. Am J Nephrol. 1985;5(2):73–83. doi: 10.1159/000166911.
    1. Jin DC. Current status of dialysis therapy in Korea. Korean J Intern Med. 2011;26(2):123–131. doi: 10.3904/kjim.2011.26.2.123.
    1. Kim SY, Jin DC, Bang BK. Current status of dialytic therapy in Korea. Nephrology. 2003;8(Suppl):S2–S9.
    1. Lai FM, Szeto CC, Choi PC, Li PK, Chan AW, Tang NL, Lui SF, Wang AY, To KF. Characterization of early IgA Nephropathy. Am J Kidney Dis. 2000;36(4):703–708. doi: 10.1053/ajkd.2000.17614.
    1. Koyama A, Igarashi M, Kobayashi M. Natural history and risk factors for immunoglobulin A nephropathy in Japan. Research Group on Progressive Renal Diseases. Am J Kidney Dis. 2000;29(4):526–532.
    1. Kiryluk K, Li Y, Sanna-Cherchi S, Rohanizadegan M, Suzuki H, Eitner F, Snyder HJ, Choi M, Hou P, Scolari F, Izzi C, Gigante M, Gesualdo L, Savoldi S, Amoroso A, Cusi D, Zamboli P, Julian BA, Novak J, Wyatt RJ, Mucha K, Perola M, Kristiansson K, Viktorin A, Magnusson PK, Thorleifsson G, Thorsteinsdottir U, Stefansson K, Boland A, Metzger M. et al.Geographic differences in genetic susceptibility to IgA nephropathy: GWAS replication study and geospatial risk analysis. PLoS Genet. 2012;8(6):e1002765. doi: 10.1371/journal.pgen.1002765.
    1. Barbour SJ, Cattran DC, Kim SJ, Levin A, Wald R, Hladunewich MA, Reich HN. Individuals of Pacific Asian origin with IgA nephropathy have an increased risk of progression to end-stage renal disease. Kidney Int. 2013;84(5):1017–1024. doi: 10.1038/ki.2013.210.
    1. Remuzzi G, Bertani T. Pathophysiology of progressive nephropathies. N Engl J Med. 1998;339(20):1448–1456. doi: 10.1056/NEJM199811123392007.
    1. Daniel L, Saingra Y, Giorgi R, Bouvier C, Pellissier JF, Berland Y. Tubular lesions determine prognosis of IgA nephropathy. Am J Kidney Dis. 2000;35(1):13–20. doi: 10.1016/S0272-6386(00)70295-2.
    1. Lai KN. Pathogenesis of IgA nephropathy. Nat Rev Nephrol. 2012;8(5):275–283. doi: 10.1038/nrneph.2012.58.
    1. Cattran DC, Coppo R, Cook HT, Feehally J, Roberts IS, Troyanov S, Alpers CE, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn JA, D’Agati V, D’Amico G, Emancipator S, Emma F, Ferrario F, Fervenza FC, Florquin S, Fogo A, Geddes CC, Groene HJ, Haas M, Herzenberg AM, Hill PA, Hogg RJ, Hsu SI, Jennette JC, Joh K, Julian BA. et al.The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int. 2009;76(5):534–545. doi: 10.1038/ki.2009.243.
    1. Kang SH, Choi SR, Park HS, Lee JY, Sun IO, Hwang HS, Chung BH, Park CW, Yang CW, Kim YS, Choi YJ, Choi BS. The Oxford classification as a predictor of prognosis in patients with IgA nephropathy. Nephrol Dial Transplant. 2012;27(1):252–258. doi: 10.1093/ndt/gfr295.
    1. Xie J, Kiryluk K, Wang W, Wang Z, Guo S, Shen P, Ren H, Pan X, Chen X, Zhang W, Li X, Shi H, Li Y, Gharavi AG, Chen N. Predicting progression of IgA nephropathy: new clinical progression risk score. PLoS One. 2012;7(6):e38904. doi: 10.1371/journal.pone.0038904.
    1. Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, Levin A, Levey AS. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305(15):1553–1559. doi: 10.1001/jama.2011.451.
    1. Keane WF, Brenner BM, De Zeeuw D, Grunfeld JP, McGill J, Mitch WE, Ribeiro AB, Shahinfar S, Simpson RL, Snapinn SM, Toto R. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study. Kidney Int. 2003;63(4):1499–1507. doi: 10.1046/j.1523-1755.2003.00885.x.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa