- 期刊
- OpenAccess
Long-Term Outcome of IGA Nephropathy-Experience of a Single Center
IgA腎絲球腎炎長期追蹤結果－單一醫學中心的經驗
摘要
Background: IgA nephropathy (IgA N) is the worldwide most common primary glomerulonephritis. The long-term outcome and the prognosis factors of IgA N in Taiwanese patients have rarely been addressed. Methods: We retrospectively reviewed our kidney biopsy database of the past 25 years. Cases with biopsy-proven IgA N were identified and medical charts were reviewed. Patients with inadequate data were excluded. A proportion of cases (157 patients) have adequate biopsy tissue to give further pathological classification according to the criteria suggested by Haas et al2. The patients were divided into subgroups according to their outcome at last follow-up. The ”stable” group includes patients in remission (normal renal function, no more hematuria defined as RBC ＜ 2/HPF and proteinuria ＜0.2 gm/day) and patients with stable renal function without signs of progression (variation in serum creatinine level less than 10% with or without hematuria/proteinuria). The ”progressive” group includes patients with deteriorating renal function (serum creatinine increased by more than 10%) and patients with end-stage renal disease (ESRD). We compare the differences in several parameters, such as initial level of creatinine, proteinuria, and pathological subclass, between the two groups. Results: A total of 436 cases (male: female =241:195, 55.5%: 44.5%) with a mean follow-up duration of 7.0 ± 6.1 years (median: 5.5 years) were enrolled fur the study. The mean age at biopsy was 35.4 ± 13.7 years, while the duration of apparent disease onset to biopsy was 1.4 ± 2.7 years (median: 0.3 years). At last follow-up, 256 cases (58.7%) had various degrees of renal function deterioration. Compared with patients in remission or with stable renal function, the progressive group had higher baseline serum creatinine (3.2 ± 3.7 vs. 1.3 ± 0.7 mg/dl, p ＜0.0001), higher urine protein (2.5 ± 2.6 vs. 2.4 ± 4.0 gm/day, p＜0.0001), and higher incidence of hepatitis C virus infection (14.3% vs. 4%, p＜0.005). The progressive groups also tended to have higher grade of Haas's subclassification (21.8% with subclass 5, compared with 1.1% in the stable group, p＜0.0001). Conclusion: We conclude that a significant proportion of IgA N patients may progress to renal insufficiency in the long run. Baseline characteristics including laboratory exam at onset and pathological-finding may predict long-term outcome and are worth further investigation.
並列摘要
Background: IgA nephropathy (IgA N) is the worldwide most common primary glomerulonephritis. The long-term outcome and the prognosis factors of IgA N in Taiwanese patients have rarely been addressed. Methods: We retrospectively reviewed our kidney biopsy database of the past 25 years. Cases with biopsy-proven IgA N were identified and medical charts were reviewed. Patients with inadequate data were excluded. A proportion of cases (157 patients) have adequate biopsy tissue to give further pathological classification according to the criteria suggested by Haas et al2. The patients were divided into subgroups according to their outcome at last follow-up. The ”stable” group includes patients in remission (normal renal function, no more hematuria defined as RBC ＜ 2/HPF and proteinuria ＜0.2 gm/day) and patients with stable renal function without signs of progression (variation in serum creatinine level less than 10% with or without hematuria/proteinuria). The ”progressive” group includes patients with deteriorating renal function (serum creatinine increased by more than 10%) and patients with end-stage renal disease (ESRD). We compare the differences in several parameters, such as initial level of creatinine, proteinuria, and pathological subclass, between the two groups. Results: A total of 436 cases (male: female =241:195, 55.5%: 44.5%) with a mean follow-up duration of 7.0 ± 6.1 years (median: 5.5 years) were enrolled fur the study. The mean age at biopsy was 35.4 ± 13.7 years, while the duration of apparent disease onset to biopsy was 1.4 ± 2.7 years (median: 0.3 years). At last follow-up, 256 cases (58.7%) had various degrees of renal function deterioration. Compared with patients in remission or with stable renal function, the progressive group had higher baseline serum creatinine (3.2 ± 3.7 vs. 1.3 ± 0.7 mg/dl, p ＜0.0001), higher urine protein (2.5 ± 2.6 vs. 2.4 ± 4.0 gm/day, p＜0.0001), and higher incidence of hepatitis C virus infection (14.3% vs. 4%, p＜0.005). The progressive groups also tended to have higher grade of Haas's subclassification (21.8% with subclass 5, compared with 1.1% in the stable group, p＜0.0001). Conclusion: We conclude that a significant proportion of IgA N patients may progress to renal insufficiency in the long run. Baseline characteristics including laboratory exam at onset and pathological-finding may predict long-term outcome and are worth further investigation.