Abstract
IgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide. According to the Oxford Classification, changes in the kidney vascular compartment are not related with worse outcomes. This paper aims to assess the impact of thrombotic microangiopathy (TMA) in the outcomes of Brazilian patients with IgAN. Analysis of clinical data and kidney biopsy findings from patients with IgAN to assess the impact of TMA on renal outcomes. The majority of the 118 patients included were females (54.3%); mean age of 33 years (25;43); hypertension and hematuria were observed in 67.8% and 89.8%, respectively. Median creatinine: 1.45mg/dL; eGFR: 48.8ml/min/1.73m2; 24-hour proteinuria: 2.01g; low serum C3: 12.5%. Regarding to Oxford Classification: M1: 76.3%; E1: 35.6%; S1: 70.3%; T1/T2: 38.3%; C1/C2: 28.8%. Average follow-up: 65 months. Histologic evidence of TMA were detected in 21 (17.8%) patients and those ones presented more frequently hypertension (100% vs. 61%, p <0.0001), hematuria (100% vs 87.6%, p = 0.0001), worse creatinine levels (3.8 vs. 1.38 mg/dL, p = 0.0001), eGFR (18 vs. 60 ml/min/1.73m2), p = 0.0001), low serum C3 (28.5% vs. 10.4%, p = 0.003), lower hemoglobin levels (10.6 vs. 12.7g/dL, p<0.001) and platelet counts (207,000 vs. 267,000, p = 0.001). Biopsy findings of individuals with TMA revealed only greater proportions of E1 (68% vs. 32%, p = 0.002). Individuals with TMA were followed for less time (7 vs. 65 months, p<0.0001) since they progressed more frequently to chronic kidney disease (CKD) requiring kidney replacement therapy (KRT) (71.4% vs. 21,6%, p<0.0001). Male sex, T1/T2, and TMA were independently associated with progression to CKD-KRT. In this study patients with TMA had worse clinical manifestations and outcomes. In terms of histologic evidence, E1 distinguished patients with TMA from other patients. Further studies are necessary to analyze the impact of vascular lesions on IgAN prognosis.
Highlights
IgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide
The following clinical data were considered at the time of kidney biopsy: age; sex; serum creatinine (SCr); estimated glomerular filtration rate (e-GFR); 24-hour proteinuria and/or urine protein/creatinine (UPC) ratio; hematuria; hypertension; serum C3 level; serum IgA; hemoglobin; platelet count; lactate dehydrogenase (LDH); and indirect bilirubin
Some clinical findings associated with worse outcomes in individuals with IgAN – male sex, older age, persistent microscopic hematuria, hypertension, proteinuria, and creatinine levels on kidney biopsy21-24 – have been described as a factor in the progression to chronic kidney disease (CKD)-kidney replacement therapy (KRT) within five years seen in approximately 30% of the individuals with the condition.[4,22,25]
Summary
IgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide. According to the Oxford Classification, changes in the kidney vascular compartment are not related with worse outcomes. IgA nephropathy (IgAN) is a highly prevalent condition worldwide and ranks as the most common primary glomerulopathy in some countries.[1,2,3] Given the high prevalence of the disease and the fact that about 30% of the patients with IgAN progress to chronic kidney disease (CKD) requiring kidney replacement therapy (KRT),[1,4] it is imperative to identify clinical and histology markers associated with worse renal outcomes. The Oxford Classification (OC)[6,7] was first published in 2009 as an attempt to identify kidney biopsy alterations possibly associated with worse outcomes in patients with IgAN. An updated version of the Oxford Classification was published in 2017,8 and cellular crescents were added as markers of worse renal outcomes
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