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Open Access Highly Accessed Research article

Long-term prognosis of clinically early IgA nephropathy is not always favorable

Hajeong Lee1, Jin Ho Hwang2, Jin Ho Paik3, Hyun Jin Ryu1, Dong Ki Kim1, Ho Jun Chin4, Yun Kyu Oh5, Kwon Wook Joo1, Chun Soo Lim5, Yon Su Kim1 and Jung Pyo Lee5*

Author Affiliations

1 Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea

2 Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea

3 Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea

4 Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

5 Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea

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BMC Nephrology 2014, 15:94  doi:10.1186/1471-2369-15-94

Published: 19 June 2014

Abstract

Background

The long-term prognosis of clinically early IgA nephropathy (IgAN) patients remains to be clarified. We investigated the long-term outcomes of IgAN patients with an apparently benign presentation and evaluated prognostic factors for renal survival.

Methods

We included patients with biopsy-proven IgAN who had estimated glomerular filtration rates (eGFR) ≥60 mL/min/1.73 m2, normal blood pressure, and proteinuria <0.5 g/day at the time of biopsy. The primary outcome was progression to end-stage renal disease (ESRD). The secondary outcome was a 50% increase in serum creatinine level or an increase in proteinuria to >1 g/day.

Results

The analysis included 153 patients who met the inclusion criteria. At diagnosis, their median systolic blood pressure was 120 (110–130) mmHg, eGFR was 85.9 (74.9–100.1) mL/min/1.73 m2, and proteinuria was 0.25 (0.13–0.38) g/day. Of these, 4 patients died and 6 reached ESRD. The 30-year renal survival rate was 85.5%. Three patients had increased serum creatinine levels and 11 developed proteinuria. Remission was observed in 35 (22.9%) patients. A moderate or severe degree of interstitial fibrosis (adjusted odd ratio [OR] 5.93, 95% confidence interval [CI] 1.44–24.45, P = 0.014) and hypoalbuminemia (adjusted OR 6.18, 95% CI 1.20–31.79, P = 0.029) were independent predictors of the secondary outcome.

Conclusions

This study showed that the prognosis of early IgAN was not always favorable, even resulting in progression to ESRD in some cases. Hypoalbuminemia and interstitial fibrosis should also be considered important prognostic factors in clinically early IgAN patients.

Keywords:
IgA nephropathy; Interstitial fibrosis; Progression of renal failure