Clinicopathological characteristics of patients with immunoglobulin A nephropathy showing acute exacerbations after favorable long-term clinical courses

2015 ◽  
Vol 20 (2) ◽  
pp. 226-234 ◽  
Author(s):  
Mai Tanaka ◽  
Yoichi Miyazaki ◽  
Kentaro Koike ◽  
Hiroyuki Ueda ◽  
Nobuo Tsuboi ◽  
...  
Author(s):  
Han Ouyang ◽  
Jian Wen ◽  
Kai Song ◽  
Huaying Shen

IntroductionImmunoglobulin (Ig) G deposition in patients with IgA nephro­pathy (IgAN) often indicates poor prognosis, but the relationship between IgM deposition and the clinicopathology of IgAN remains controversial. The purpose of this study is to further understand the relationship between IgM deposition and IgAN, so as to provide a basis for clinical evaluation and treatment.Material and methodsWe included a total of 839 IgAN patients from the nephropathy departments of 2 hospitals; there were 162 IgM-positive patients and 677 IgM-negative patients. Clinical and pathological data were retrospectively analysed. In addition, a multifaceted comparison was made between the IgM-positive group and the IgM-negative group.ResultsThe serum albumin and IgG levels of the IgM-positive group were lower than those of the IgM-negative group, and the levels of low-density lipo­protein, 24 h proteinuria, and IgM were higher than those of the IgM-nega­tive group. The proportion of endothelial cell proliferation (E1), segmental sclerosis or adhesion (S1), and renal tubular interstitial score in the IgM-posi­tive group were all higher than those in the IgM-negative group. Immunofluo­rescence results showed that the proportion of IgM-positive combination and IgG and C1q deposition was higher than that in the IgM-negative group.ConclusionsImmunoglobulin A nephropathy patients with IgM deposition have relatively poor clinical biochemical indicators, and the degree of renal pathological damage is also relatively serious.


Nephrology ◽  
2008 ◽  
Vol 13 (3) ◽  
pp. 242-246 ◽  
Author(s):  
JICHENG LV ◽  
HONG ZHANG ◽  
YANG ZHOU ◽  
GUANGTAO LI ◽  
WANZHONG ZOU ◽  
...  

2018 ◽  
Vol 35 (6) ◽  
pp. 1002-1009 ◽  
Author(s):  
Rosanna Coppo ◽  
Graziella D'Arrigo ◽  
Giovanni Tripepi ◽  
Maria Luisa Russo ◽  
Ian S D Roberts ◽  
...  

Abstract Background It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up. Methods In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1–10.8)]. Results In this extended analysis, M1, S1 and T1–T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%). Conclusion Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.


Author(s):  
Kar Neng Lai ◽  
Sydney C. W. Tang

Immunoglobulin A nephropathy is characteristically slowly evolving, and studies from autopsies and kidney donors show that deposition of immunoglobulin A is quite common and not necessarily associated with overt disease. However, series of biopsy-diagnosed patients that extend to 20 or 30 years report rates of end-stage renal failure of up to 40–50%. A very approximate overall rate of end-stage renal disease of 1% per year has been suggested. Proteinuria, glomerular filtration rate (GFR), and possibly some features on renal biopsies enable risk stratification, but all patients need long-term monitoring. Treatment is based on the use of angiotensin converting-enzyme inhibitors for patients with proteinuria, and blood pressure control, and of course during most of the previous long-term studies patients would not have been treated with these agents or to modern blood pressure standards. For patients who show loss of GFR despite this, or other markers of high risk, the best evidence is for treatment with high-dose corticosteroids over a limited period of months. There is little convincing evidence for additional benefit from cytotoxic or other immunomodulatory agents, except possibly in the most aggressive disease, when there is weak evidence for cyclophosphamide. Some studies claim benefit from tonsillectomy, but this is not clear, and most nephrologists only recommend this for patients with recurrent tonsillitis.


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