Clinical and Histopathological Predictors of Renal Survival in IgA Nephropathy Patients with Nephrotic Range Proteinuria: A Retrospective Survival Analysis
Renal Survival in IgAN
Abstract views: 24
/ 
PDF downloads: 1
DOI:
https://doi.org/10.5281/zenodo.13951013Keywords:
IgA nephropathy, proteinuria, nephrotic range, crescentic glomerulonephritis, renal survival, treatment outcomeAbstract
Background: IgA nephropathy (IgAN) presents with a wide spectrum of clinical features, most commonly hematuria accompanied by subnephrotic proteinuria. Nephrotic range proteinuria is rare, observed in approximately 6% of patients at diagnosis. Limited studies have examined the relationship between clinicopathological characteristics and renal prognosis in IgAN patients with nephrotic range proteinuria.
Methods: This retrospective, single-center case-control study included 114 patients diagnosed with IgAN via kidney biopsy at Şişli Hamidiye Etfal Training and Research Hospital from April 2004 to December 2016. Patients were divided into two groups: nephrotic (≥ 3.5 g/day) and subnephrotic (<3.5 g/day) proteinuria. Primary outcomes included a doubling of serum creatinine, while secondary outcomes measured the initiation of renal replacement therapy.
Results: Patients with nephrotic range proteinuria had significantly lower serum albumin levels (p=0.001), higher cholesterol levels (p=0.03), and increased fibrocellular crescent formation (p=0.01). Cox regression analysis identified baseline serum creatinine, uric acid, and albumin levels, along with histopathological findings such as glomerulosclerosis and crescent formation, as significant predictors of treatment response. The Kaplan-Meier analysis showed that patients with nephrotic range proteinuria had worse renal survival, with a significantly higher proportion reaching primary and secondary endpoints compared to the subnephrotic group.
Conclusion: Histopathological findings, particularly fibrocellular crescents, were more common in patients with nephrotic range proteinuria, and their presence was associated with poorer renal survival and lower treatment response rates. These patients require closer follow-up and may benefit from more aggressive therapeutic strategies.
References
Berger J, Hinglais N. Intercapillary deposits of IgA-IgG. J Urol Nephrol (Paris). 1968;74(9):694-695.
Schena FP, Nistor I. Epidemiology of IgA nephropathy: a global perspective. Semin Nephrol. (2018) 38:435–42. doi: 10.1016/j.semnephrol.2018.05.013.
McGrogan A, Franssen CF, de Vries CS. The incidence of primary glomerulonephritis worldwide: a systematic review of the literature. Nephrol Dial Transplant. 2010;25(2):414-430.
Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China: analysis based on 13,519 renal biopsies. Kidney Int. 2004;66(3):920-923.
Turkmen, A., Sumnu, A., Cebeci, E., et al. (2020). Epidemiological features of primary glomerular disease in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group. BMC nephrology, 21, 1-11.
Floege J, Feehally J. IgA nephropathy: recent developments. J Am Soc Nephrol. 2000;11(12):2395-2403.
Barratt J, Smith AC, Feehally J. Immunopathogenesis of IgA nephropathy. Semin Immunopathol. 2007;29(4):427-443.
Nihei Y, Kitamura D. Pathogenesis of IgA nephropathy as a tissue-specific autoimmune disease. Int Immunol. Published online July 27, 2024. doi:10.1093/intimm/dxae047
Rovin, B. H., Adler, S. G., Barratt, J., et al (2021). Executive summary of the KDIGO 2021 guideline for the management of glomerular diseases. Kidney international, 100(4), 753-779.
Caster DJ, Abner CW, Walker PD, et al. Clinicopathological Characteristics of Adult IgA Nephropathy in the United States [published correction appears in Kidney Int Rep. 2023 Oct 05;8(12):2842. doi: 10.1016/j.ekir.2023.10.002]. Kidney Int Rep. 2023;8(9):1792-1800. Published 2023 Jun 28. doi:10.1016/j.ekir.2023.06.016
Tang C, Chen P, Si FL, et al. Time-Varying Proteinuria and Progression of IgA Nephropathy: A Cohort Study. Am J Kidney Dis. 2024;84(2):170-178.e1. doi:10.1053/j.ajkd.2023.12.016
K Petrou, D., Kalogeropoulos, P., Liapis, G., & Lionaki, S. (2023). IgA Nephropathy: Current Treatment and New Insights. Antibodies (Basel, Switzerland), 12(2), 40.
Liang M, Zhang X, Zhou J, et al. Clinicopathological characteristics and renal outcomes in IgA nephropathy patients with nephrotic range proteinuria. Int J Clin Exp Pathol. 2016;9(4):4531-4538.
Barbour, S., & Reich, H. (2018). An update on predicting renal progression in IgA nephropathy. Current opinion in nephrology and hypertension, 27(3), 214–220.
Shao X, Li B, Cao L, et al. Evaluation of crescent formation as a predictive marker in immunoglobulin A nephropathy: a systematic review and meta-analysis. Oncotarget. 2017;8(28):46436.
Jia Z, Shan L, Jianqing J, et al. Clinical pathological analysis and treatment of IgA nephropathy with a few quantities of renal crescent formation. J Nephrol Therapeutic. 2011;1:107.
Liang M, Zhang X, Zhou J, et al. Clinicopathological characteristics and renal outcomes in IgA nephropathy patients with nephrotic range proteinuria. Int J Clin Exp Pathol. 2016;9(4):4531-4538.
Silva GE, Costa RS, Lobato ET, et al. A case series of diffuse crescentic IgA nephropathy: an omitted entity in the Oxford classification. Int J Clin Exp Pathol. 2016;9(2):1909-1916.
Walsh M, Sar A, Lee D, et al. Histopathologic features aid in predicting risk for progression of IgA nephropathy. Clin J Am Soc Nephrol. 2010;5:425-430.
Katafuchi R, Ninomiya T, Nagata M, et al. Validation study of Oxford classification of IgA nephropathy: the significance of extracapillary proliferation. Clin J Am Soc Nephrol. 2011;6(12):2806-2813
Berthoux F, Mohey H, Laurent B, et al. Predicting the risk for dialysis or death in IgA nephropathy. J Am Soc Nephrol. 2011;22(4):752-761.
Reich HN, Troyanov S, Scholey JW, et al. Remission of proteinuria improves prognosis in IgA nephropathy. J Am Soc Nephrol. 2007;18(12):3177-3183.
Tumlin JA, Hennigar RA. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol. 2004;24:256-268.
Rovin, B. H., Adler, S. G., Barratt, J., Bridoux, F., Burdge, K. A., Chan, T. M., ... & Floege, J. (2021). Executive summary of the KDIGO 2021 guideline for the management of glomerular diseases. Kidney international, 100(4), 753-779.
Ikee R, Kobayashi S, Saigusa T, et al. Impact of hypertension and hypertension-related vascular lesions in IgA nephropathy. Hypertens Res. 2006;29(1):15-22.
Izzi C, Ravani P, Torres D, et al. IgA nephropathy: the presence of familial disease does not confer an increased risk for progression. Am J Kidney Dis. 2006;47(5):761-769.
Shirai, S., Yasuda, T., Kumagai, H. et al. Prognostic factors of IgA nephropathy presenting with mild proteinuria at the time of diagnosis (a multicenter cohort study). Clin Exp Nephrol 27, 340–348 (2023). https://doi.org/10.1007/s10157-023-02316-2
Qin A, Yang D, Wang S, Dong L, Tan J, Tang Y, Qin W. Uric acid-based ratios for predicting renal failure in Chinese IgA nephropathy patients. Int J Med Sci 2023; 20(12):1584-1591. doi:10.7150/ijms.85430. https://www.medsci.org/v20p1584.htm
Ni Z, Yuan Y, Wang Q, et al. Time-averaged albumin predicts the long-term prognosis of IgA nephropathy patients who achieved remission. J Transl Med. 2014;12:194. Published 2014 Jul 10. doi:10.1186/1479-5876-12-194
Zhang K, Tang L, Jiang SS, et al. Is hyperuricemia an independent prognostic factor for IgA nephropathy: a systematic review and meta-analysis of observational cohort studies. Ren Fail. 2022;44(1):70-80. doi:10.1080/0886022X.2021.2019589
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Feyza Bayrakdar Çağlayan, Taner Baştürk, Abdülkadir Ünsal
This work is licensed under a Creative Commons Attribution 4.0 International License.
The journal is licensed under a 