Prediction of diagnosis of immunoglobulin a nephropathy prior to renal biopsy and correlation with urinary sediment findings and prognostic grading

Background and Aim: Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulopathy. The Oxford classification was recently updated to include crescents as markers of poor prognosis. The aim of this study was to evaluate the impact of cellular crescents on the prognosis of patients with IgAN in Brazil. Methods: This was a single-centre retrospective analysis of medical records and renal biopsies in patients with IgAN. The renal biopsy findings were classified according to the revised Oxford classification: mesangial hypercellularity, endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy or interstitial fibrosis (T), and crescent formation (C). We evaluated a composite outcome (progression to end-stage renal disease or creatinine doubling). We performed analyses between the patients with crescents in the renal biopsy specimen (C1/C2 group) and those without such crescents (C0 group). Results: We evaluated 111 patients, of whom 72 (65.0%) were women, 80 (72.0%) self-identified as White, 73 (65.6%) were hypertensive, and 95 (85.6%) had haematuria. The distribution of patients according to cellular crescentic lesions was: C0, 80 (72%); C1, 27 (24.4%); C2, 4 (3.6%). The composite outcome was observed in 33 (29.72%) of the 111 patients. In comparison with the C0 group, the C1/C2 group had higher proportions of patients with hypertension (p = 0.04), haematuria (p = 0.03), worse serum creatinine (p = 0.0007), and worse estimated glomerular filtration rate (p = 0.0007). The C1/C2 group also had higher proportions of patients in whom the biopsy specimen was classified as E1 (p = 0.009), S1 (p = 0.001), or T1/T2 (p = 0.03), In addition, the mean follow-up period was shorter in the C1/C2 group (p < 0.0001). Furthermore, the composite outcome was observed in a greater proportion of patients and in a shorter length of time in the C1/C2 group than in the C0 group (p = 0.002 and p = 0.0014, respectively). In a Cox regression analysis, the independent risk factors for the composite outcome had Oxford classifications of S1, T1/T2, and C1/C2. Conclusion: Oxford classification findings of S1, T1/T2, or C1/C2 were independent risk factors for the composite outcome, corroborating previous studies.

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Immunoglobulin A nephropathy and Henoch–Schönlein purpura

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.210801_update_002 ◽

2010 ◽

pp. 3971-3977

Author(s):

Jonathan Barratt ◽

John Feehally

Keyword(s):

Renal Biopsy ◽

Immunoglobulin A ◽

Hinge Region ◽

Proliferative Glomerulonephritis ◽

Mesangial Proliferative Glomerulonephritis ◽

Immunoglobulin A Nephropathy ◽

Glomerular Mesangium ◽

The World ◽

Schonlein Purpura ◽

Henoch Schönlein Purpura

Immunoglobulin A nephropathy (IgAN) is the commonest pattern of glomerulonephritis identified in areas of the world where renal biopsy is widely practised. It is defined pathologically by IgA deposition in the glomerular mesangium accompanied by a mesangial proliferative glomerulonephritis which may vary greatly in severity. Aetiology is uncertain, but abnormalities of IgA1 hinge-region ...

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Quantification of platelet‐derived growth factor A, factor B and receptor β in human renal biopsy tissue using competitive reverse transcriptase polymecase chain reaction: comparison between immunoglobulin A nephropathy and thin membrane nephropathy

Nephrology ◽

10.1046/j.1440-1797.2000.00018.x ◽

2000 ◽

Vol 5 (4) ◽

pp. 271-276

Author(s):

Robyn G Langham ◽

Melissa K Egan ◽

John P DOWLING2 ◽

Napier M THOMSON1

Keyword(s):

Growth Factor ◽

Reverse Transcriptase ◽

Renal Biopsy ◽

Immunoglobulin A ◽

Platelet Derived Growth Factor ◽

Thin Membrane ◽

Immunoglobulin A Nephropathy ◽

Chain Reaction ◽

Factor B ◽

Biopsy Tissue

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Immunoglobulin A nephropathy: Basic characteristics

Medicinski pregled ◽

10.2298/mpns0306281p ◽

2003 ◽

Vol 56 (5-6) ◽

pp. 281-285

Author(s):

Lada Petrovic ◽

Slobodan Curic ◽

Igor Mitic ◽

Dusan Bozic ◽

Slavenka Vodopivec ◽

...

Keyword(s):

Light Microscopy ◽

Renal Biopsy ◽

Clinical Features ◽

Serological Test ◽

Immunoglobulin A ◽

Vascular Lesions ◽

Immunoglobulin A Nephropathy ◽

Macroscopic Hematuria ◽

Female Ratio ◽

Pathologic Features

Introduction Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis in many countries. Most clinical features of IgAN point to a renal problem, such as recurrent macroscopic hematuria or asymptomatic microscopic hematuria and proteinuria. Pathologic features of IgAN present with different types and different degrees of glomerular tubulointerstitial and vascular lesions. The aim of this study was detailed analysis of clinical and laboratory findings, as well as findings of immunofluorescence and light microscopy. We also investigated associations between these factors. Material and methods We investigated 60 patients who underwent renal biopsy. The study was partly retrospective and partly prospective. Results The average age of patients was 34.19 years. Male female ratio was 2.33:1. IgAN was most frequently asymptomatic (83.33%) as microhematuria and proteinuria, while gross hematuria was found in 16.667%. Renal biopsy material was analyzed by light microscopy revealing changes in all glomerular structures. Immunofluorescence microscopy demonstrated dominant IgA deposits. This study established association of glomerulosclerosis with clinical features of disease. Discussion and conclusions IgAN frequently develops in the 4th decade of life, mostly in males and presents as asymptomatic (83.33%). Patohistological changes include all glomerular structures. There is no specific serological test for IgAN, but pathological changes affect clinical features of the disease, as proteinuria and increase of creatinine concentration.

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Expressions of mRNA for innate immunity-associated functional molecules in urinary sediment in immunoglobulin A nephropathy

Nephrology ◽

10.1111/nep.12533 ◽

2015 ◽

Vol 20 (12) ◽

pp. 916-921

Author(s):

Kazushi Tsuruga ◽

Tomomi Aizawa ◽

Shojiro Watanabe ◽

Koji Tsugawa ◽

Hidemi Yoshida ◽

...

Keyword(s):

Innate Immunity ◽

Immunoglobulin A ◽

Immunoglobulin A Nephropathy ◽

Urinary Sediment

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Tuberculosis-associated IgA nephropathy

Journal of International Medical Research ◽

10.1177/0300060518774127 ◽

2018 ◽

Vol 46 (7) ◽

pp. 2549-2557 ◽

Cited By ~ 2

Author(s):

Yamei Wang ◽

Yuhong Tao

Keyword(s):

Renal Function ◽

Mycobacterium Tuberculosis ◽

Renal Biopsy ◽

Iga Nephropathy ◽

Immunoglobulin A ◽

Diagnostic Value ◽

Accurate Diagnosis ◽

Pathological Diagnosis ◽

Immunoglobulin A Nephropathy ◽

Reduced Renal Function

Immunoglobulin A nephropathy (IgAN) is the most frequent pathological diagnosis of tuberculosis (TB)-associated glomerulonephritis. Diagnosing TB-associated IgAN (TB-IgAN) is difficult because of its non-specific and insidious symptoms. An inaccurate diagnosis of TB-IgAN could result in the spread of TB and reduced renal function. Haematuria and proteinuria in conjunction with TB should be assessed because of the potential for diagnosis of IgAN. Renal biopsy is important in securing an accurate diagnosis prior to initiating treatment. Detection of Mycobacterium tuberculosis DNA and assessment of early secreted antigenic target of 6 kDa in renal biopsy tissues may have great potential diagnostic value in patients with TB-IgAN. Anti-TB therapy can effectively alleviate TB and TB-IgAN.

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Immunoglobulin A nephropathy and its prognostic factors

Medicinski pregled ◽

10.2298/mpns0212517p ◽

2002 ◽

Vol 55 (11-12) ◽

pp. 517-522

Author(s):

Lada Petrovic ◽

Slobodan Curic ◽

Igor Mitic ◽

Dusan Bozic ◽

Slavenka Vodopivec ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Renal Biopsy ◽

Clinical Features ◽

Normal Renal Function ◽

Immunoglobulin A ◽

Immunoglobulin A Nephropathy ◽

Laboratory Findings ◽

Heavy Proteinuria ◽

The Moment

Introduction Immunoglobulin A nephropathy (IgAN) is a clinicopathological entity characterized by diffuse glomerular mesangial deposition of IgA as the predominant immunoglobulin. Renal biopsy reveals a spectrum of changes in glomerula, tubulointerstitium and blood vessels. 20-50% of all patients develop end-stage renal failure 20 years after onset of disease. The aim of this study was to investigate the incidence of IgAN and to analyze clinicopathological changes and prognosis of IgAN. Material and methods The study included 60 patients with biopsy-proved IgAN without some other systemic diseases or Henoch-Schonlen purpura. We analyzed clinical features of the disease, laboratory findings, findings of immunofluorescence and light microscopy and prognosis of IgAN. The study is partly retrospective and partly prospective. Results and discussion Incidence of the disease in the period 1981-1997 was 9.78%. At the moment of renal biopsy 63.16% of patients had normal renal function, 31.58% had stage I and 5.25% had stage II chronic renal failure. At the end of study 21.05% of investigated patients were included into the worse stage of renal failure in regard to the initial stage. Progression of renal damage correlated with special tubulointerstitial damage and heavy proteinuria. Conclusions In this study we found severe histopathological changes in the group with already impaired renal function and these changes correlated with laboratory findings, clinical features and prognosis. Normal renal function at the moment of renal biopsy pointed to risk for further damage. Changes in the tubulointerstitium and mesangium, heavy proteinuria and hypertension affect the disease prognosis. Evolution to the higher stage of renal failure was 1.24% per year and this requires long-term follow-up of patients with IgAN.

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Defective gene expression of the membrane complement inhibitor CD46 in patients with progressive immunoglobulin A nephropathy

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy064 ◽

2018 ◽

Vol 34 (4) ◽

pp. 587-596 ◽

Cited By ~ 7

Author(s):

Rosanna Coppo ◽

Licia Peruzzi ◽

Elisa Loiacono ◽

Massimilano Bergallo ◽

Alexandra Krutova ◽

...

Keyword(s):

Gene Expression ◽

Renal Biopsy ◽

Messenger Rna ◽

White Blood Cells ◽

Immunoglobulin A ◽

Outcome Variable ◽

Mrna Levels ◽

Immunoglobulin A Nephropathy ◽

Arterial Blood ◽

Significant Difference

Abstract Background Complement is thought to play a role in immunoglobulin A nephropathy (IgAN), though the activating mechanisms are unknown. This study focused on the gene expression of CD46 and CD55, two key molecules for regulating C3 convertase activity of lectin and alternative complement pathways at a cellular level. Methods The transcriptional expression in peripheral white blood cells (WBCs) of CD46 and CD55 was investigated in 157 patients enrolled by the Validation of the Oxford Classification of IgAN group, looking for correlations with clinical and pathology features and estimated glomerular filtration rate (eGFR) modifications from renal biopsy to sampling. Patients had a previous median follow-up of 6.4 (interquartile range 2.8–10.7) years and were divided into progressors and non-progressors according to the median value of their velocity of loss of renal function per year (−0.41 mL/min/1.73 m2/year). Results CD46 and CD55 messenger RNA (mRNA) expression in WBCs was not correlated with eGFR values or proteinuria at sampling. CD46 mRNA was significantly correlated with eGFR decline rate as a continuous outcome variable (P = 0.014). A significant difference was found in CD46 gene expression between progressors and non-progressors (P = 0.013). CD46 and CD55 mRNA levels were significantly correlated (P < 0.01), although no difference between progressors and non-progressors was found for CD55 mRNA values. The prediction of progression was increased when CD46 and CD55 mRNA expressions were added to clinical data at renal biopsy (eGFR, proteinuria and mean arterial blood pressure) and Oxford MEST-C (mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis, tubular atrophy/interstitial fibrosis, presence of any crescents) score. Conclusions Patients with progressive IgAN showed lower expression of mRNA encoding for the complement inhibitory protein CD46, which may implicate a defective regulation of C3 convertase with uncontrolled complement activation.

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