Indian scenario of IgA nephropathy: a systematic review and meta-analysis.

Anju Khairwa

doi:10.4314/ahs.v21i1.21

Abstract

IgA nephropathy (IgAN) is most common primary glomerulopathy. There are variations in prevalence of IgAN and its clinical features in different studies from India. To summarize overall scenario of IgAN in India. In this systematic review, studies related to IgAN and related renal disease were included. Data searched were PubMed, EMBASE, Google scholar, and Cochrane Database from inception to 31st January 2019. Total 49 studies (N=2480) were included: 21 studies (N=2309) of primary IgAN; 19 studies (N=21) of Secondary IgAN; four studies (N=133) of IgA vasculitis nephropathy (IgAVN); and five studies (N=17) of IgA dominant nephropathy (IgADN). Prevalence of IgAN was 16.5% in India. Age of affected persons was ranging from 27.2±16.7 to 48.6±21.3 years . Male female ratio was 1.8:1. Clinical features of Primary IgAN, IgAVN, IgADN & Secondary IgAN were microscopic hematuria (49.6%, 44.4%, 15.6% & 59.5%), macroscopic hematuria (5.1%, 0.4%,40.9%,& 35.7%), Subnephrotic proteinuria (42.1%, 29.4%, 23.2%, & 52.3%), nephrotic proteinuria (16.0%, 4.4%, 76.8%,& 47.6%), and hypertension (25.8%,18.3%, 35.5%,& 47.6%).. The 24 hours proteinuria was ranging from 2.6±1.5 to 4.7±2.3 gm/day and serum creatinine (mg/dl) was ranging from 0.9±0 to 3.5±3.9 mg/dl. Histolomorphologically, all type of IgAN showed mesangial hypercellularity and Immunofluorescence revealed IgA deposition.. The overall prevalence of primary IgAN in India was 16.5%. The subnephrotic proteinuria and microscopic hematuria were common clinical features.

Highlights

IgA nephropathy (IgAN) was first demonstrated by Berger in 1768.1 It is characterized by persistent microscopic hematuria, sub-nephrotic proteinuria, episodic gross hematuria, normal to severe impairment of renal function and hypertension.[1,2]
We found higher prevalence of IgAN in comparison to study by Seedate et al (13.3%) from African country Natal done on Indians.[27]
Primary IgAN and Secondary IgAN was found in younger age groups and it is reported by other studies[29,30] Males were more commonly effected than females and our findings corroborated with other studies[27,29] We found that IgA dominant nephropathy (IgADN) was presented in higher age group (48.6±21.3) than Primary IgAN, IgA vasculitis nephropathy (IgAVN), and Secondary IgAN

Summary

Introduction

IgA nephropathy (IgAN) was first demonstrated by Berger in 1768.1 It is characterized by persistent microscopic hematuria, sub-nephrotic proteinuria, episodic gross hematuria, normal to severe impairment of renal function and hypertension.[1,2] Histomorphology varies from normal to chronic glomerulonephritis on renal biopsy of these patients. The most common histomorphology is focal glomerulonephritis.[1,2] On immunofluorescence microscopy (IF), all cases had mesangial deposition of IgA dominantly and less commonly weak staining for IgG and C3. IgA nephropathy (IgAN) is most common primary glomerulopathy. There are variations in prevalence of IgAN and its clinical features in different studies from India. Clinical features of Primary IgAN, IgAVN, IgADN & Secondary IgAN were microscopic hematuria (49.6%, 44.4%, 15.6% & 59.5%), macroscopic hematuria (5.1%, 0.4%,40.9%,& 35.7%), Subnephrotic proteinuria (42.1%, 29.4%, 23.2%, & 52.3%), nephrotic proteinuria (16.0%, 4.4%, 76.8%,& 47.6%), and hypertension (25.8%,18.3%, 35.5%,& 47.6%). Conclusion: The overall prevalence of primary IgAN in India was 16.5%.

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