Clinical and Histopathological Factors Influencing IgA Nephropathy Outcome

IgA nephropathy (IgAN) is the most frequent primary glomerulonephritis worldwide. Due to its heterogenicity, there is a need to establish robust biomarkers for IgAN, to support treatment decisions and evaluate the risk of progression to end-stage renal disease. Using both clinical and histopathological data, derived from renal biopsies, we aimed to find predictors of renal function deterioration and proteinuria reduction. Clinical and histopathological data of 80 patients with biopsy proven IgAN were analyzed. In a multivariate logarithmic regression model, the presence of endocapillary hypercellularity (E1) predicted a decline in estimated glomerular filtration rate (eGFR)of at least 50% with an odds ratio (OR) of 15.2, whereas serum albumin concentration had a negative influence on eGFR deterioration (OR 0.2). In the second multivariate model, the extent of interstitial fibrosis predicted the worsening of eGFR by 50% (OR 1.1) and serum albumin concentration had a protective impact (OR 0.1). In the univariate logarithmic regression, both the extent of interstitial fibrosis and the presence of endocapillary hypercellularity negatively correlated with the reduction in proteinuria below 1.0 g/24 h with an OR of 0.2 and 0.9, respectively. In our paper, we confirmed the utility of histopathological variables, especially endocapillary hypercellularity and interstitial fibrosis, and clinical parameters, particularly serum albumin concentration, in the prediction of both a decline in eGFR and a reduction in proteinuria in IgA nephropathy.

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Serum albumin concentration and risk of end-stage renal disease: the REGARDS study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx331 ◽

2017 ◽

Vol 33 (10) ◽

pp. 1770-1777 ◽

Cited By ~ 1

Author(s):

Carl P Walther ◽

Orlando M Gutiérrez ◽

Mary Cushman ◽

Suzanne E Judd ◽

Joshua Lang ◽

...

Keyword(s):

Risk Factors ◽

Renal Disease ◽

Serum Albumin ◽

End Stage Renal Disease ◽

Albumin Concentration ◽

Serum Albumin Concentration ◽

Lower Serum ◽

Regards Study ◽

Stage Renal Disease ◽

End Stage

ABSTRACT Background Serum albumin concentration is a commonly available biomarker with prognostic value in many disease states. It is uncertain whether serum albumin concentrations are associated with incident end-stage renal disease (ESRD) independently of urine albumin-to-creatinine ratio (ACR). Methods A longitudinal evaluation was performed of a population-based community-living cohort from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Participants were ≥45 years of age at study entry and had serum albumin, creatinine, cystatin C and spot urine ACR measured at the baseline visit (n = 19 633). Estimated glomerular filtration rate (eGFR) was from the Chronic Kidney Disease Epidemiology Collaboration combined creatinine-cystatin C equation. Baseline serum albumin concentration was the predictor variable, and hazard ratios (HRs) for incident ESRD (from US Renal Data System linkage) were calculated in sequentially adjusted models. Results Age at study entry was 63.9 ± 9.7 years, 62% of the participants were female and 40% were black. Mean eGFR at baseline was 83.3 ± 20.8 mL/min/1.73 m2. Over a median 8-year follow-up, 1.2% (n = 236) developed ESRD. In models adjusted for baseline eGFR, ACR and other ESRD risk factors, the HR for incident ESRD was 1.16 [95% confidence interval (CI) 1.01–1.33] for each standard deviation (0.33 g/dL) lower serum albumin concentration. The HR comparing the lowest (<4 g/dL) and highest quartiles (≥4.4 g/dL) of serum albumin was 1.61 (95% CI 0.98–2.63). Results were qualitatively similar among participants with eGFR <60 and ≥60 mL/min/1.73 m2, and those with and without diabetes. Conclusions In community-dwelling US adults, lower serum albumin concentration is associated with higher risk of incident ESRD independently of baseline urine ACR, eGFR and other ESRD risk factors.

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The Effect of Acidosis on Albumin Level in Patients Treated With Regular Hemodialysis (Single Center Study)

Global Journal of Health Science ◽

10.5539/gjhs.v10n11p57 ◽

2018 ◽

Vol 10 (11) ◽

pp. 57

Author(s):

Manal Khudder Abdul Razak ◽

Jawad Ibrahim Rasheed ◽

Mudhafar Mohammed Meizel

Keyword(s):

Metabolic Acidosis ◽

Renal Disease ◽

Serum Albumin ◽

End Stage Renal Disease ◽

Albumin Level ◽

Albumin Concentration ◽

Serum Albumin Concentration ◽

Serum Bicarbonate ◽

Stage Renal Disease ◽

End Stage

BACKGROUND: Hypoalbuminemia is the most powerful predictor of mortality in end-stage renal disease on hemodialysis. Metabolic acidosis induces net negative nitrogen and total body protein balance. Some patients undergoing maintenance dialysis have low plasma bicarbonate levels due to inadequate dialysis. We aimed to evaluate the role of metabolic acidosis on serum albumin concentration in patients with end stage renal disease on hemodialysis, and to determine differences of serum bicarbonate level before and after hemodialysis in actual situation. METHODS: This cross sectional comparative study was conducted in the Iraqi Center for Hemodialysis/ Baghdad Teaching Hospital from June to December 2015. It included 100 subjects with end stage renal disease on hemodialysis. They were divided equally into cases with low albumin and comparison group with normal albumin level. Serum bicarbonate and the Kt/V were measured for all subjects before, after, and before next hemodialysis session to show the adequacy of dialysis. RESULTS: There was a significant association between low bicarbonate and low albumin level in hemodialysis patient and between numbers and duration of dialysis session with albumin. Low Kt/V was significantly associated with hypoalbuminemia. There was no statistically significant association between age and gender with hypoalbuminemia. CONCLUSION: This study shows that patients with metabolic acidosis had a lower serum albumin concentration and there was a significant correlation between numbers, duration and adequacy of hemodialysis sessions and albumin level. We recommend to increase the numbers of dialysis centers in Iraq and adjust the bicarbonate doses in dialysate according to patient’s bicarbonate levels.

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Faculty Opinions recommendation of Low Birth Weight and Risk of Progression to End Stage Renal Disease in IgA Nephropathy--A Retrospective Registry-Based Cohort Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726295475.793520368 ◽

2016 ◽

Author(s):

Luis Ruilope ◽

Enrique Morales

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Low Birth Weight ◽

Renal Disease ◽

Iga Nephropathy ◽

End Stage Renal Disease ◽

Risk Of Progression ◽

Stage Renal Disease ◽

End Stage

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Low Birth Weight and Risk of Progression to End Stage Renal Disease in IgA Nephropathy—A Retrospective Registry-Based Cohort Study

PLoS ONE ◽

10.1371/journal.pone.0153819 ◽

2016 ◽

Vol 11 (4) ◽

pp. e0153819 ◽

Cited By ~ 13

Author(s):

Paschal Ruggajo ◽

Einar Svarstad ◽

Sabine Leh ◽

Hans-Peter Marti ◽

Anna Varberg Reisæther ◽

...

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Low Birth Weight ◽

Renal Disease ◽

Iga Nephropathy ◽

End Stage Renal Disease ◽

Risk Of Progression ◽

Stage Renal Disease ◽

End Stage

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Individuals of Pacific Asian origin with IgA nephropathy have an increased risk of progression to end-stage renal disease

Kidney International ◽

10.1038/ki.2013.210 ◽

2013 ◽

Vol 84 (5) ◽

pp. 1017-1024 ◽

Cited By ~ 57

Author(s):

Sean J. Barbour ◽

Daniel C. Cattran ◽

S Joseph Kim ◽

Adeera Levin ◽

Ron Wald ◽

...

Keyword(s):

Renal Disease ◽

Iga Nephropathy ◽

End Stage Renal Disease ◽

Asian Origin ◽

Increased Risk ◽

Risk Of Progression ◽

Stage Renal Disease ◽

End Stage

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Emerging Modes of Treatment of IgA Nephropathy

International Journal of Molecular Sciences ◽

10.3390/ijms21239064 ◽

2020 ◽

Vol 21 (23) ◽

pp. 9064

Author(s):

Dita Maixnerova ◽

Vladimir Tesar

Keyword(s):

Renal Disease ◽

Iga Nephropathy ◽

End Stage Renal Disease ◽

Treatment Effectiveness ◽

Treatment Options ◽

Slowing Down ◽

Non Invasive ◽

Risk Of Progression ◽

Stage Renal Disease ◽

End Stage

IgA nephropathy is the most common primary glomerulonephritis with potentially serious outcome leading to end stage renal disease in 30 to 50% of patients within 20 to 30 years. Renal biopsy, which might be associated with risks of complications (bleeding and others), still remains the only reliable diagnostic tool for IgA nephropathy. Therefore, the search for non-invasive diagnostic and prognostic markers for detection of subclinical types of IgA nephropathy, evaluation of disease activity, and assessment of treatment effectiveness, is of utmost importance. In this review, we summarize treatment options for patients with IgA nephropathy including the drugs currently under evaluation in randomized control trials. An early initiation of immunosupressive regimens in patients with IgA nephropathy at risk of progression should result in the slowing down of the progression of renal function to end stage renal disease.

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IgA Nephropathy Recurrence after Kidney Transplantation: Role of Recipient Age and Human Leukocyte Antigen-B Mismatch

American Journal of Nephrology ◽

10.1159/000506853 ◽

2020 ◽

Vol 51 (5) ◽

pp. 357-365

Author(s):

Lida M. Rodas ◽

Estibaliz Ruiz-Ortiz ◽

Adriana Garcia-Herrera ◽

Arturo Pereira ◽

Miquel Blasco ◽

...

Keyword(s):

Human Leukocyte Antigen ◽

Iga Nephropathy ◽

Protective Factor ◽

Human Leukocyte ◽

Clinical Indication ◽

Renal Outcome ◽

Leukocyte Antigen ◽

Risk Of Progression ◽

Stage Renal Disease ◽

End Stage

Background: Recurrence of immunoglobulin (Ig)A nephropathy (rIgAN) is a growing cause of kidney allograft dysfunction. This study was aimed at investigating factors associated with rIgAN and the subsequent progression to end-stage renal disease (ESRD). Methods: Retrospective study including consecutive patients with IgA nephropathy (IgAN) who received a kidney transplant in our center between 1992 and 2016 and had a renal biopsy by clinical indication. The date of detection of chronic kidney disease (CKD) 5 was used as renal outcome. Results: Eighty-six kidney transplants were performed in patients with IgAN, 38 (44%) were from living donors (related n = 26). rIgAN was diagnosed in 23 allografts (27%). Renal function and proteinuria at the end of the follow-up period were worst in the rIgAN patients compared to those without rIgAN (2.2 vs. 1.4 mg/dL, p = 0.014, and 1.16 vs. 0.49 g/day, p = 0.005, respectively). Risk of rIgAN and progression to CKD 5 decreased with patient’s age (hazard ratio [HR] 0.95, 95% CI 0.92–0.98, p = 0.002, and HR 0.97, 95% CI 0.83–0.97, p = 0.008 per year, respectively). Patients with rIgAN had a higher risk of progression to CKD 5 (HR 6.7, 95% CI 1.3–35.7, p = 0.025). Full donor-recipient mismatch in the human leukocyte antigen (HLA)-B loci decreased the risk of rIgAN (HR 0.22, 95% CI 0.06–0.76, p = 0.017). Conclusions: rIgAN was an independent risk factor for ESRD after renal allograft. Younger age increased the risk of rIgAN and CKD 5. Conversely, HLA-B mismatching was a potential protective factor for rIgAN of this glomerular disease.

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