scholarly journals Serum IL-18 Is Closely Associated with Renal Tubulointerstitial Injury and Predicts Renal Prognosis in IgA Nephropathy

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Beili Shi ◽  
Zhaohui Ni ◽  
Liou Cao ◽  
Minjie Zhou ◽  
Shan Mou ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Renal Outcome ◽  
Tubulointerstitial Injury ◽  
Baseline Serum ◽  
Protein Excretion ◽  
Kaplan Meier ◽  
Tubulointerstitial Damage ◽  
Renal Prognosis ◽  
Cox Analysis

Background. IgA nephropathy (IgAN) was thought to be benign but recently found it slowly progresses and leads to ESRD eventually. The aim of this research is to investigate the value of serum IL-18 level, a sensitive biomarker for proximal tubule injury, for assessing the histopathological severity and disease progression in IgAN.Methods. Serum IL-18 levels in 76 IgAN patients and 36 healthy blood donors were measured by ELISA. We evaluated percentage of global and segmental sclerosis (GSS) and extent of tubulointerstitial damage (TID). The correlations between serum IL-18 levels with clinical, histopathological features and renal prognosis were evaluated.Results. The patients were38.85±10.95years old, presented with 2.61 (1.43∼4.08) g/day proteinuria. Serum IL-18 levels were significantly elevated in IgAN patients. Baseline serum IL-18 levels were significantly correlated with urinary protein excretion (r=0.494,P=0.002), Scr (r=0.61,P<0.001), and eGFR (r=−0.598,P<0.001). TID scores showed a borderline significance with serum IL-18 levels (r=0.355,P=0.05). During follow-up, 26 patients (34.21%) had a declined renal function. Kaplan-Meier analysis found those patients with elevated IL-18 had a significant poor renal outcome (P=0.03), and Cox analysis further confirmed that serum IL-18 levels were an independent predictor of renal prognosis (β=1.98,P=0.003).

scholarly journals Lower serum bilirubin is associated with poor renal outcome in IgA nephropathy patients: A retrospective study

2021 ◽  
Author(s):  
Zheng Jiang ◽  
Jiaxing Tan ◽  
Siqing Wang ◽  
Lingqiu Dong ◽  
Xin Han ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Renal Outcome ◽  
Baseline Serum ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
High Bilirubin ◽  
Group Serum

Abstract Background: IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis worldwide. It is meaningful to identify risk factors related to the development of IgAN. We conducted this study to explore the relationship between serum bilirubin and renal outcome of patients with IgAN.Methods: In this retrospective observational study, 1492 biopsy proven IgAN patients were recruited and divided into two groups according to their median baseline serum bilirubin concentration: the low bilirubin group (serum bilirubin≤9.7umol/L, n=753) and high bilirubin group (serum bilirubin>9.7umol/L, n=739). Basic clinical characteristics were assessed at the time of renal biopsy and the relationships between serum bilirubin and the combined endpoints were analyzed. In addition, propensity score matching (PSM) was performed to improve balance and simulate randomization between patients in different groups. Kaplan-Meier survival analysis was applied to explore the role of serum bilirubin in the progression of IgAN. Three models (including demographic, clinical, pathological features and serum bilirubin) of multivariate Cox regression analysis were established to evaluate the association of serum bilirubin and renal prognosis of IgAN.Results: During median 5-year follow-up period, significant differences were shown in Kaplan-Meier analysis. In the unmatched group, 189 (12.7%) patients progressed to the renal combined endpoints. Among this, 122 in 753 patients (16.2%) were in low bilirubin group and 67 in 739 patients (9.1%) were in high bilirubin group (p<0.001). After PSM, there were 134 (11.8%) patients reached the combined endpoints, which included 77 in 566 patients (14.6%) in low bilirubin group and 57 in 566 patients (10.1%) in high bilirubin group (p=0.039). The results of three models (including demographics, pathological, clinical indicators and serum bilirubin) demonstrated that a lower basic serum bilirubin level was significantly associated with a higher risk of reaching combined endpoints in IgAN patients both in unmatched and matched cohort. Conclusion: Serum bilirubin level may be negatively associated with the progression of IgAN.

Volume of Crescents Affects Prognosis of IgA Nephropathy in Patients without Obvious Chronic Renal Pathology

2021 ◽  
pp. 1-12
Author(s):  
Zaoqiang Lin ◽  
Lichang Liu ◽  
Rongling Zhang ◽  
Xuefei Lin ◽  
Fuhua Lu ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Kidney Tissue ◽  
Treatment Modalities ◽  
Renal Outcome ◽  
Renal Lesions ◽  
Increased Risk ◽  
Lower Egfr ◽  
The Oxford Classification ◽  
Renal Prognosis

<b><i>Introduction:</i></b> A working group on the Oxford classification of IgA nephropathy (IgAN) recently reported that crescents detected in the kidney tissue predicted a worse renal outcome. However, the effect of C1 lesion (crescents in &#x3c;1/4th of all glomeruli) and their volume on the prognosis of IgAN is still unclear. We explored the association of C1 lesion with the renal prognosis in IgAN patients without obvious chronic renal lesions (glomerulosclerosis &#x3c;25%, T score &#x3c;2). <b><i>Methods:</i></b> We investigated 305 biopsy-proven IgAN patients without obvious chronic renal lesions. Clinicopathologic features and treatment modalities were recorded. The patients were divided into several groups according to the presence or absence of a global crescent: no crescent (NC) group, only segmental crescent (SC) group, and global crescent (GC) group. The outcome was the survival from a combined event defined by a ≥15% decline in the estimated glomerular filtration rate (eGFR) after 1 year or ≥30% decline in the eGFR after 2 years. <b><i>Results:</i></b> Among all patients, 75.7% were in the NC group, 14.8% were in the SC group, and 9.5% were in the GC group. Compared with the NC group, patients in the SC group and the GC group had more urine protein, lower eGFR, and presented with more severe pathological change. During a median follow-up of 34.8 (26.16–57.95) months, the combined event occurred in 34 individuals (11.1%). In a multivariate model, the GC group (HR = 2.756, 95% CI = 1.068–7.109) was associated with an increased risk of the combined event. <b><i>Conclusions:</i></b> In IgAN patients without obvious chronic renal lesions, the GC group had more severe clinical and pathological manifestations than in the NC group. GC is an independent risk factor for the progression of IgAN renal function.

scholarly journals Characteristics of patients with coexisting DNAJB9-associated fibrillary glomerulonephritis and IgA nephropathy

2020 ◽  
Author(s):  
Samar M Said ◽  
Alejandro Best Rocha ◽  
Anthony M Valeri ◽  
Mohamad Sandid ◽  
Anhisekh Sinha Ray ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Immunoglobulin A ◽  
Renal Survival ◽  
Hepatitis C Infection ◽  
Clinicopathologic Characteristics ◽  
Fibrillary Glomerulonephritis ◽  
Kaplan Meier ◽  
Dense Deposits ◽  
End Stage

Abstract Background Coexistence of fibrillary glomerulonephritis (FGN) and immunoglobulin A (IgA) nephropathy (IgAN) in the same kidney biopsy (FGN–IgAN) is rare, and the clinicopathologic characteristics and outcome of this dual glomerulopathy are unknown. Methods In this study, 20 patients with FGN–IgAN were studied and their characteristics were compared with 40 FGN and 40 IgAN control patients. Results Concurrent IgAN was present in 1.8% of 847 consecutive FGN cases and was the second most common concurrent glomerulopathy after diabetic nephropathy. FGN–IgAN patients were overwhelmingly White (94%) and contrary to FGN patients were predominantly (60%) males. Compared with IgAN patients, FGN–IgAN patients were older, had higher proteinuria, a higher incidence of renal insufficiency, and a lower incidence of microhematuria and gross hematuria at diagnosis. Six (30%) patients had malignancy, autoimmune disease or hepatitis C infection, but none had a secondary cause of IgAN or clinical features of Henoch–Schonlein purpura. Histologically, all cases exhibited smudgy glomerular staining for immunoglobulin G and DnaJ homolog subfamily B member 9 (DNAJB9) with corresponding fibrillary deposits and granular mesangial staining for IgA with corresponding mesangial granular electron-dense deposits. On follow-up (median 27 months), 10 of 18 (56%) FGN–IgAN patients progressed to end-stage kidney disease (ESKD), including 5 who subsequently died. Serum creatinine at diagnosis was a poor predictor of renal survival. The proportion of patients reaching ESKD or died was higher in FGN–IgAN than in IgAN. The median Kaplan–Meier ESKD-free survival time was 44 months for FGN–IgAN, which was shorter than IgAN (unable to compute, P = 0.013) and FGN (107 months, P = 0.048). Conclusions FGN–IgAN is very rare, with clinical presentation and demographics closer to FGN than IgAN. Prognosis is guarded with a median renal survival of 3.6 years. The diagnosis of this dual glomerulopathy requires careful evaluation of immunofluorescence findings, and electron microscopy or DNAJB9 immunohistochemistry.

scholarly journals A multicenter, prospective, observational study to determine association of mesangial C1q deposition with renal outcomes in IgA nephropathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Li Tan ◽  
Yi Tang ◽  
Gaiqin Pei ◽  
Zhengxia Zhong ◽  
Jiaxing Tan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iga Nephropathy ◽  
Cox Regression ◽  
Renal Outcome ◽  
Matched Cohort ◽  
Negative Group ◽  
Renal Survival ◽  
Cox Regression Analysis ◽  
Renal Outcomes

AbstractIt was reported that histopathologic lesions are risk factors for the progression of IgA Nephropathy (IgAN). The aim of this study was to investigate the relationships between mesangial deposition of C1q and renal outcomes in IgAN. 1071 patients with primary IgAN diagnosed by renal biopsy were enrolled in multiple study centers form January 2013 to January 2017. Patients were divided into two groups: C1q-positive and C1q-negative. Using a 1: 4 propensity score matching (PSM) method identifying age, gender, and treatment modality to minimize confounding factors, 580 matched (out of 926) C1q-negative patients were compared with 145 C1q-positive patients to evaluate severity of baseline clinicopathological features and renal outcome. Kaplan–Meier and Cox proportional hazards analyses were performed to determine whether mesangial C1q deposition is associated with renal outcomes in IgAN. During the follow-up period (41.89 ± 22.85 months), 54 (9.31%) patients in the C1q negative group and 23 (15.86%) patients in C1q positive group reached the endpoint (50% decline of eGFR and/or ESRD or death) respectively (p = 0.01) in the matched cohort. Significantly more patients in C1q negative group achieved complete or partial remission during the follow up period (P = 0.003) both before and after PSM. Three, 5 and 7-year renal survival rates in C1q-positive patients were significantly lower than C1q-negative patients in either unmatched cohort or matched cohort (all p < 0.05). Furthermore, multivariate Cox regression analysis showed that independent risk factors influencing renal survival included Scr, urinary protein, T1-T2 lesion and C1q deposition. Mesangial C1q deposition is a predictor of poor renal survival in IgA nephropathy.Trial registration TCTR, TCTR20140515001. Registered May 15, 2014, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1074.

scholarly journals Grading system utilising the total score of Oxford classification for predicting renal prognosis in IgA nephropathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoei Miyabe ◽  
Kazunori Karasawa ◽  
Kenichi Akiyama ◽  
Shota Ogura ◽  
Tomo Takabe ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Clinical Findings ◽  
Grading System ◽  
Oxford Classification ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
The Oxford Classification ◽  
Renal Prognosis ◽  
Renal Survival Rate

AbstractThe Oxford classification of IgA nephropathy (IgAN) can evaluate each MEST-C score individually. We analysed a new grading system that utilised the total MEST-C score in predicting renal prognosis. Altogether, 871 IgAN patients were classified into three groups using the new Oxford classification system (O-grade) that utilised the total MEST-C score (O-grade I: 0–1, II: 2–4, and III: 5–7 points), and the 10-year renal prognosis was analysed. The clinical findings became significantly severer with increasing O-grades, and the renal survival rate by the Kaplan–Meier method was 94.1%, 86.9%, and 74.1% for O-grades I, II, and III, respectively. The hazard ratios (HRs) for O-grades II and III with reference to O-grade I were 2.8 (95% confidence interval [CI] 1.3–6.0) and 6.3 (95% CI 2.7–14.5), respectively. In the multivariate analysis, mean arterial pressure and eGFR, proteinuria at the time of biopsy, treatment of corticosteroids/immunosuppressors, and O-grade (HR 1.63; 95% CI 1.11–2.38) were the independent factors predicting renal prognosis. Among the nine groups classified using the O-grade and Japanese clinical-grade, the renal prognosis had an HR of 15.2 (95% CI 3.5–67) in the severest group. The O-grade classified by the total score of the Oxford classification was associated with renal prognosis.

Interstitial Inflammatory and Chronic Tubulointerstitial Lesions in Lupus Nephritis: Comparison with those in IgA Nephropathy

Lupus ◽  
1993 ◽  
Vol 2 (1_suppl) ◽  
pp. 261-268 ◽  
Author(s):  
Tatsuo Yamamoto ◽  
Mitsumasa Nagase ◽  
Akira Hishida ◽  
Nishio Honda
Keyword(s):  
Lupus Nephritis ◽  
Iga Nephropathy ◽  
Immune Complexes ◽  
Prognostic Significance ◽  
Underlying Disease ◽  
Inflammatory Lesions ◽  
Tubulointerstitial Lesions ◽  
Glomerular Lesions ◽  
Renal Prognosis

The significance of interstitial inflammatory and chronic tubulointerstitial lesions was studied in relation to the severity of glomerular lesions in 62 patients with lupus nephritis and 88 with IgA nephropathy. Severe interstitial inflammatory and chronic tubulointerstitial lesions were found in patients with severe glomerular lesions in both lupus nephritis and IgA nephropathy. In such cases, the serum creatinine levels at biopsy were high and the renal prognosis was poor regardless of the underlying disease (lupus nephritis or IgA nephropathy). No IgA nephropathy patients with nil or mild glomerular lesions had moderate or severe interstitial inflammatory and/or chronic tubulointerstitial lesions. In contrast, predominantly severe interstitial inflammatory lesions were found in 36% of lupus nephritis patients with nil or mild glomerular lesions. The prevalence of interstitial immune complexes deposition was markedly high in those with predominant interstitial inflammatory lesions. However, the severity of chronic tubulointerstitial lesions was mild and renal function did not deteriorate in the mean follow-up periods of 68.6 months. It is suggested that, besides the tubulointerstitial lesions attributable to the severe concomitant glomerular damage, the interstitial deposition of immune complexes per se plays a pathogenic role in the interstitial inflammatory lesions in lupus nephritis. Its prognostic significance, however, was considered to be minor.

scholarly journals Comparison of Mortality between Japanese Peritoneal Dialysis and Hemodialysis Patients: A 5-Year Multicenter Follow-Up Study

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Kazuko Suzuki ◽  
Tsuneo Konta ◽  
Kazunobu Ichikawa ◽  
Ami Ikeda ◽  
Hiroki Niino ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Japanese Patients ◽  
Diabetic Patients ◽  
Dialysis Modality ◽  
Multicenter Observational Study ◽  
Kaplan Meier ◽  
The Difference ◽  
Cox Analysis ◽  
The Relationship

To examine the relationship between dialysis modality and prognosis in Japanese patients, we conducted a prospective multicenter observational study. We recruited 83 background-matched peritoneal dialysis (PD) and 83 hemodialysis (HD) patients (average age, 64.9 years; men, 53.6%; diabetic patients, 22.9%; median duration of dialysis, 48 months in all patients) and followed them for 5 years. During the follow-up period, 27 PD patients (16 cardiovascular and 11 non-cardiovascular deaths) and 27 HD patients died (14 cardiovascular and 13 non-cardiovascular deaths). There were 8 PD patients switched to HD, and 6 PD patients received renal transplantation. Kaplan-Meier analysis revealed that the crude survival rate was not significantly different at the end of 5 years (PD 67.5% versus 67.5%, log-rankP=0.719). The difference in cardiovascular and non-cardiovascular mortalities between PD and HD was not statistically significant. Multivariate Cox analysis showed that the independent predictors for death were age and serum albumin levels, but not the dialysis modality. This study showed that the overall mortality was not significantly different between PD and HD patients, which suggests that dialysis modality might not be an independent factor for survival in Japanese patients.

Focal segmental glomerulosclerosis histologic variants and renal outcomes based on nephrotic syndrome, immunosuppression, and proteinuria remission

2021 ◽  
Author(s):  
Takehiko Kawaguchi ◽  
Toshiyuki Imasawa ◽  
Moritoshi Kadomura ◽  
Hiroshi Kitamura ◽  
Shoichi Maruyama ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Focal Segmental Glomerulosclerosis ◽  
Renal Outcome ◽  
Renal Outcomes ◽  
Not Otherwise Specified ◽  
Segmental Glomerulosclerosis ◽  
Subgroup Analyses ◽  
Renal Prognosis ◽  
End Stage

Abstract Background The associations of focal segmental glomerulosclerosis (FSGS) histologic variants with renal outcomes have rarely been investigated comprehensively by clinically relevant subgroups in this modern age. Methods Data on 304 (173 nephrotic and 131 non-nephrotic) patients with biopsy-confirmed FSGS from 2010 to 2013 were analyzed using the Japanese nationwide renal biopsy registry. The primary outcome was a composite of a 30% decline in estimated glomerular filtration rate or progression to end stage kidney disease 5 years from the biopsy. We compared outcomes of FSGS variants according to the Columbia classification using survival analyses. Subgroup analyses were performed based on nephrotic syndrome (NS), immunosuppression, and proteinuria remission (PR, proteinuria &lt;0.3 g/day) during follow-up. Additionally, associations of NS, immunosuppression, and PR with outcomes were examined for each variant. Results The distribution of variants was 48% (n = 145) FSGS not otherwise specified (NOS), 19% (n = 57) tip, 15% (n = 47) perihilar, 13% (n = 40) cellular, and 5% (n = 15) collapsing. The outcome event occurred in 87 patients (29%). No significant differences in the outcome were found among the variants. Subgroup analyses yielded similar results. However, there was a trend toward improved outcome in patients with PR irrespective of variants (hazard ratio adjusted for histologic variant and potential confounders [adjusted HR]: 0.19 [95% confidence interval (CI), 0.10–0.34]). NS was marginally associated with better outcome compared with non-NS (adjusted HR: 0.50 [95% CI, 0.25–1.01]. Conclusions FSGS variants alone might not have significant impacts on the renal outcome after 5 years, while PR could be predictive of improved renal prognosis for any variant. Specific strategies and interventions to achieve PR for each variant should be implemented for better renal outcomes.

MO287REAL WORLD COMPARISON OF THE PREDICTIVE UTILITY OF INTERNATIONAL IGA RISK PREDICTION SCORE AND KIDNEY FAILURE RISK EQUATION IN IGA NEPHROPATHY PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sophia Mohammed ◽  
Rajkumar Chinnadurai ◽  
Arvind Ponnusamy
Keyword(s):  
Iga Nephropathy ◽  
Risk Prediction ◽  
Kidney Failure ◽  
Renal Outcome ◽  
Predictive Utility ◽  
Statistical Validation ◽  
Risk Equation ◽  
Failure Risk ◽  
Stage Renal Disease

Abstract Background and Aims IgA nephropathy is the most prevalent cause of glomerular disease worldwide. The international IgA risk prediction (IgAN) score is a well validated tool to predict the risk of 50% decline in eGFR or end stage renal disease (ESRD) at five years after biopsy in patients with IgA nephropathy. Also, the four variable kidney failure risk equation (KFRE) is another validated tool used to predict the two- and five-year risk of progression to ESRD of all cause chronic kidney disease (CKD 3-5). Our aim is to compare the predictive utility of IgAN score and the KFRE in a real-world cohort of Caucasian patients with long-term follow-up data. Method All available patients with biopsy-proven IgA nephropathy in our centre between January 2001 and December 2013 were included in this observational study. Baseline (biopsy date) data relevant to the scores including demographics, laboratory and the histopathological features were collated at the time of biopsy. Follow up data on renal functions and renal outcome (50% decline in eGFR or reaching ESRD) were collected until an arbitrary end date 31/12/2018. Results We had a total of 115 patients recorded over this 13-year period. The median age of our cohort at time of biopsy was 41 years. Men represented 71% of the cohort. At baseline 84% were hypertensive and 11% diabetic. 77% were on a renin-angiotensin blocker, with 53% being on a statin. Out of the 115 patients, 74 were eligible to undergo analysis. The percentage risk of reaching the endpoint (50% decline in eGFR or reaching ESRD) was calculated at 2 years and 5 years for all patients. These results can be seen in table 1 and 2. At 2 years, 7 patients had reached the endpoint: 2 patients had a &gt;50% decline in eGFR, 3 patients received RRT and 2 patients underwent transplantation. At 5 years, 14 patients had reached the endpoint: 3 patients had a &gt;50% decline in eGFR, 6 patients received RRT and 5 underwent transplantation. Conclusion Our data suggests that the KRFE tool underpredicts the risk of reaching endpoint, compared to the IgAN. Our study has helped to compare the two tools, but further statistical validation is required using a larger cohort.

Lymphopenia at diagnosis of ANCA-vasculitis with renal involvement is correlated with severity and renal prognosis

2021 ◽  
Author(s):  
Samuel Wacrenier ◽  
Jérémie Riou ◽  
Pierre Jourdain ◽  
Fanny Guibert ◽  
Nicolas Henry ◽  
...  
Keyword(s):  
Renal Involvement ◽  
Cost Effective ◽  
Renal Outcome ◽  
Small Scale ◽  
Free Survival ◽  
Kidney Replacement Therapy ◽  
Histological Data ◽  
Renal Prognosis ◽  
Cox Analysis ◽  
End Stage

ABSTRACT Background Lymphopenia is commonly observed in autoimmune diseases, where it has been associated with disease activity or prognosis. However, in ANCA-associated vasculitis (AAV) only few, small-scale studies have been targeted to this issue. Research has not yet focused on AAV with renal involvement (AAV-RI) patients. Thus, the aim of this study was to analyze the association between lymphocyte counts and outcomes in a large cohort of AAV-RI patients. Methods We used the Maine-Anjou AAV registry that retrospectively gathers data on consecutive patients affected by AAV in four French Nephrology Centers, recorded since January 2000. We analyzed clinical, biological, and histological data at diagnosis of AAV-RI. Risk factors for end-stage kidney disease (ESKD) were analyzed. Event-free survival was also assessed. Results Among the 145 patients included in the study, those with lymphopenia at diagnosis had a lower renal function at baseline (eGFR 13 mL/min vs 26 mL/min, p = 0.002) and were more likely to require kidney replacement therapy (51% vs 25%, p = 0.003). Lymphopenia was correlated with histological lesions and especially with the percentage of sclerotic glomeruli (p = 0.0027). ESKD-free survival was lower in lymphopenic patients (p &lt; 0.0001). In multivariate Cox analysis, lymphopenia was an independent risk factor for ESKD (HR 4.47 (95% confidence interval: [2.06–9.72], p &lt; 0.001). Conclusion Lymphopenia correlates with the severity of AAV glomerulonephritis at diagnosis and predicts poor renal outcome. In this view, lymphopenia could be used as a simple and cost-effective biomarker to assess renal prognosis at AAV-RI diagnosis.

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