Primary Glomerulonephritis Research Articles

The Genetics of IgA Nephropathy: Implications for Future Therapies.

The Genetics of IgA Nephropathy: Implications for Future Therapies.

Serum Uric Acid/Serum Creatinine Ratio and Chronic Vascular Lesions on Renal Biopsy: A Retrospective Observational Study.

Increased serum uric acid (SUA) levels are found in cardiovascular and kidney diseases, associated with the development of vascular injury. Uric acid stimulates the inflammatory pathways, promotes vascular smooth muscle cells proliferation, activates renin-angiotensin system leading to the development and progression of vascular damage. Renal function-normalized uric acid [SUA to serum creatinine ratio (SUA/SCr)] has been suggested to be a better indicator of uric acid. To investigate the correlation between SUA level and SUA/SCr in the development of chronic and vascular lesions (CVL) in patients with primary glomerulonephritis (GN). A retrospective observational study was conducted in 95 consecutive renal native biopsies performed at Policlinico Umberto I of Rome (Italy). Patient inclusion criteria were age ≥ 18 years, a renal biopsy confirming diagnosis of primary GN, the availability of complete demographic, clinical, pathological, and laboratory data. Median SCr was 1.06 mg/dl (IQR 0.77;1.70) with a median eGFR of 70.40 ml/min (IQR 40.40;105). Median SUA was 5.90 mg/dl (IQR 4.30;6.90) and median SUA/SCr was 4.70 (IQR 3.20;6.80). CVL were reported in 56 (58.9%) patients. Median SUA/SCr was significantly lower in patients with CVL than patients without CVL [3.95 (IQR 2.65;6) vs 5.90 (IQR 4.30;7.20), p<0.01]. Logistic regression analysis showed that SUA/SCr ≤ 4.05 [OR 5.451 (95% CI 1.222;24.325), p<0.05] was independently associated with CVL. CVL play a crucial role in the progression of kidney disease. SUA/SCr ≤ 4.05 is associated with CVL in patients with primitive GN.

Kidney Transplantation in Children and Adolescents With C3 Glomerulopathy or Immune Complex Membranoproliferative Glomerulonephritis: An International Survey of Current Practice.

Approximately 50% of patients with chronic kidney disease due to C3 glomerulopathy (C3G) or primary immune-complex membranoproliferative glomerulonephritis (IC-MPGN) will require dialysis and/or kidney transplantation (KTx) within the first 10 years of disease onset. Currently, there are no guidelines regarding the indications for KTx or post-transplant management. We therefore initiated an international online survey via Survey Monkey on C3G and IC-MPGN in children with CKD stage 5. All KTx centers of the European Society for Paediatric Nephrology (ESPN) were invited to participate in the survey, which was conducted from August 23 to November 25, 2023. Sixty-five (63%) of the centers (n = 103) participated. Twenty-six percent had made at least one decision against living donation for a child with C3G or IC-MPGN. The main reason for 88.2% of these decisions was concern about the recurrence of the underlying disease in any potential transplant. Eighty-eight percent indicated deceased donation as an option; 12% decided not to proceed with transplantation at all. Regarding KTx decision-making or management, none of them referred to an existing recommendation by any national or regional guideline. For the recurrence of C3G or IC-MPGN post-transplant, eculizumab treatment was suggested by 60% of respondents. This survey shows a considerable reluctance of pediatric nephrologists to list patients with CKD stage 5 due to C3G or IC-MPGN for living donor kidney transplantation. This decision is mainly based on the fear of recurrence of the underlying disease combined with the lack of reliable treatment options. This limited access of affected patients to the best treatment option for kidney failure requires further action.

Network Pharmacological Analysis of Hydroxychloroquine Intervention in the Treatment of Iga Nephropathy.

IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis globally and has a high propensity to develop into end-stage renal disease (ESRD). Hydroxychloroquine has been proven to reduce proteinuria in IgAN patients, but the precise mechanism remains unclear. Therefore, network pharmacology was used to investigate the mechanism. PubChem and SwissADME databases were utilized to acquire the structure of hydroxychloroquine. The SwissTargetPrediction, PharmMapper, DrugBank, TargetNet, and BATMAN-TCM databases were then utilized to obtain the targets. The target genes related to IgAN were then gathered from the databases, which included GeneCards, PHARMGKB, DrugBank, OMIM, and DisGeNET. Common targets were obtained by UniProt. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to define the main molecular mechanisms and pathways. Furthermore, a protein-protein interaction (PPI) network was constructed using the STRING tool, and the core targets were obtained by Cytoscape. Finally, molecular docking between the core targets and hydroxychloroquine was performed. 167 common target genes were acquired by overlapping. The core targets were TNF, ALB, IL1B, JUN, FOS, SRC, and MMP9. The GO and KEGG results showed the targets to be related to the production of inflammatory cytokines and chemokines and were engaged in the toll-like receptor (TLR) signaling pathway. At the same time, the molecular docking results showed that the core targets all combined with hydroxychloroquine closely. This study proved that hydroxychloroquine may treat IgAN through the TLR signaling pathway, and the restraint of TNF, TLR, IL1B, and JUN may be essential for the treatment.

The Pathology of IgA Nephropathy: How Can It Inform Management?

The Pathology of IgA Nephropathy: How Can It Inform Management?

Links between oropharyngeal microbiota and IgA nephropathy: A paradigm shift from isolated microbe to microbiome.

Links between oropharyngeal microbiota and IgA nephropathy: A paradigm shift from isolated microbe to microbiome.

The Prevalence of Immunoglobulin A Nephropathy in the European Union and the Impact of the COVID-19 pandemic: An Estimation Approach Utilizing the Kidney Biopsy Frequency

Abstract Introduction IgA nephropathy (IgAN) is the most common type of primary glomerulonephritis, requiring a kidney biopsy for diagnosis. This study aimed to estimate the prevalence of primary IgAN within the European Union (EU) and investigate the potential impact of the COVID-19 pandemic on kidney biopsy rates and IgAN diagnosis frequency. Methods We conducted four comprehensive literature searches to identify data on the IgAN prevalence and incidence, native kidney biopsy rates, and COVID-19 impact on these metrics. We calculated country-specific prevalence estimates based on a combination of published and modeled data, incorporating biopsy frequency and the Healthcare Access and Quality Index (HAQI). The EU IgAN prevalence was derived from country-specific prevalence estimates weighted by population size. Results The estimated prevalence of IgAN in the EU was 4.31 per 10,000 population, with large geographic variation among countries, ranging from 0.16 to 14.4 per 10,000 population. A strong correlation was observed between the IgAN incidence and biopsy rate (R²=0.96). Countries with a higher HAQI mostly exhibited higher biopsy rates and IgAN incidences. The COVID-19 pandemic resulted in a notable decrease in kidney biopsy rates for most European countries with available information in 2020 compared to both pre- and post-pandemic periods. However, the long-term implications of this reduction on biopsy rates and subsequent IgAN incidence remain to be determined. Conclusion Our findings confirm the rarity of IgAN, albeit the most common type of glomerulonephritis. They underscore a robust correlation between biopsy rates and IgAN incidence, influenced by healthcare access and quality. The COVID-19 pandemic's temporary suppression of biopsy rates in 2020 suggests potential delays in IgAN diagnosis, warranting further investigation into the long-term effects.

Efficacy and safety of endothelin A receptor antagonists in IgA nephropathy: a systematic review and meta-analysis

Abstract Background IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. Endothelin A receptor activation is a key driver of proteinuria, inflammation and fibrosis in IgAN. This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of endothelin A receptor antagonists (EARAs) in IgAN patients. Methods PubMed, Embase, Web of Science and Cochrane Library were searched from inception to 31 October 2024. All randomized controlled trials were identified according to the inclusion criteria. Data were analyzed by RevMan 5.4. Results Four high-quality studies were included, comprising 1346 IgAN patients. Compared with control group, EARAs group achieved a greater reduction in urine protein-creatinine ratio (UPCR) (mean difference (MD): -31.89, 95% CI: -37.50 to -26.28), systolic blood pressure (BP) (MD: -2.78, 95% CI: -4.11 to -1.44), and diastolic BP (MD: -4.12, 95% CI: -5.24 to -2.99), and a smaller reduction in estimated glomerular filtration rate (eGFR) (MD: 4.10, 95% CI: -0.76 to 8.96). However, EARAs group had higher risk of anemia (odds ratio (OR): 2.38, 95% CI: 1.54 to 3.69), cough (OR: 2.27, 95% CI: 1.24 to 4.15), dizziness (OR: 2.37, 95% CI: 1.51 to 3.71), hypotension (OR: 2.39, 95% CI: 1.56 to 3.67), fluid retention (OR: 1.46, 95% CI: 1.04 to 2.05), and acute kidney injury (OR: 3.12, 95% CI: 1.31 to 7.42). Conclusion EARAs can significantly reduce UPCR, lower both systolic and diastolic BP, and delay eGFR decline in IgAN patients. But they may cause anemia, cough, dizziness, hypotension, fluid retention, and acute kidney injury.

Prognostic nutritional index as an independent risk factor for disease progression in patients with IgA nephropathy.

Immunoglobulin A nephropathy (IgAN), a common primary glomerulonephritis worldwide, has been investigated, and complex factors are involved in disease progression. A group of evidence emerged that nutrition status plays a nonsubstitutable role in the management of chronic kidney disease. Meanwhile, a novel marker of nutrition and inflammation, the prognostic nutritional index (PNI), has been studied in various diseases. Whether PNI can predict the renal outcome of patients with IgAN remains unclear. Thus, we aimed to evaluate the relationships between PNI and clinicopathologic features, renal progression and renal prognosis in patients with IgAN. A total of 1,377 patients with biopsy-proven IgAN were recruited for this retrospective study. All patients were divided into two groups based on the cutoff value of PNI: the high group (PNI ≥ 47.1, n = 886) and the low group (PNI < 47.1, n = 491). Our study endpoint was end-stage renal disease [estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m2 or performance of renal replacement therapy]. A correlation test was conducted to explore the relationship between PNI and other important clinicopathologic parameters. The predictive value was determined by the area under the receiver operating characteristic curve (AUROC). Kaplan-Meier and Cox proportional hazards analyses were performed to assess the value of PNI in predicting renal progression and prognosis. The correlation test revealed that PNI was positively associated with eGFR (r = 0.16, p < 0.001) and negatively related to 24-h proteinuria (r = -0.387, p < 0.001). Multivariate Cox regression analysis indicated that low PNI was an independent risk factor for IgAN patients even after adjusting for important clinical and pathological parameters (HR, 0.664; 95% CI, 0.443-0.994; p = 0.047). Kaplan-Meier analysis showed that low PNI was significantly correlated with severe renal outcome in patients with IgAN (p < 0.001). Moreover, the subgroup analyses of Kaplan-Meier survival demonstrated that low PNI predicted severe renal prognosis in different types of IgAN patients when considering the level of glomerular filtration rate, 24 h proteinuria and hemoglobin. PNI is associated with renal function and pathologic lesions in IgAN patients and could be a novel marker for the evaluation of renal progression and prognosis.

Yeast Cell Wall-Mediated Ileal Targeted Delivery System for IgA Nepharopathy Therapy.

IgA nephropathy (IgAN) is a primary glomerulonephritis mediated by autoimmunity, characterized by an abnormal increase and the deposition of IgA in the glomeruli. In recent years, most studies have emphasized the crucial role of the gut-kidney axis in the pathogenesis of IgA nephropathy, and the ileal Peyer patches in the intestinal mucosal immune system are the main site for IgA production. Therefore, in this study, hydroxychloroquine (HCQ) and dexamethasone (DXM) were used as model drugs, and yeast cell wall (YCW)-coated oleic acid-grafted chitosan (CSO) was used as a carrier to construct a yeast cell wall oral drug delivery system HCQ/DXM@CSO@YCW. This delivery system achieves ileal targeted delivery through the yeast cell wall (YCW), reduces IgA production, and synergistically regulates the inflammatory pathological environment. The delivery system had good gastrointestinal stability and biocompatibility. In vitro cell experiments had shown the targeted uptake ability of dendritic cells and macrophages, and in vitro intestinal experiments showed that the YCW has ileal targeting properties. In vivo pharmacodynamic experiments showed that the HCQ/DXM@CSO@YCW delivery system could significantly reduce the serum IgA levels and IgA deposition in the renal tissue of IgAN mice, as well as the levels of IL-6, TNF-α, and TGF-β in the renal tissue, improving the pathological morphology of the renal tissue. Therefore, the DXM/HCQ@CSO@YCW oral administration system provided a new intestinal targeted delivery platform for intestinal mucosal immunotherapy in IgA nephropathy.

WCN25-2592 Comparison of the Clinical Profile of IgA Nephropathy with Other Primary Glomerulonephritis in Nepalese Patients Undergoing Native Kidney Biopsy

WCN25-2592 Comparison of the Clinical Profile of IgA Nephropathy with Other Primary Glomerulonephritis in Nepalese Patients Undergoing Native Kidney Biopsy

HBE BETA-THALASSEMIA IS ASSOCIATED WITH IGA NEPHROPATHY

Thalassemia are a group of autosomal recessive inherited disorders of haemoglobin synthesis where in mutations of the -globin gene lead to various degrees of defective -chain production, an imbalance in -globin chain synthesis, ineffective erythropoiesis and anaemia. Improved survival in thalassaemic patients has led to the emergence of previously unrecognized complications, such as renal disease. Renal disease is considered the 4th cause of morbidity among patients with transfusion dependent thalassemia. IgA nephropathy (IgAN) is an immune complex-mediated glomerulonephritis, defined morphogically by the constant presence of dominant or co-dominant mesangial deposists of IgA and accompanied by avariety of histopathological lesions. It is the most common pattern of primary glomerulonephritis seen in the world and represents a significant cause of renal insufficiency in young adults. Here we report a case of 24 year old male known case of E beta thalassemia since his 8 years of age with IgA nephropathy.

Systematic review of the application of the Kidney Failure Risk Equation and Oxford classification in estimating prognosis in IgA Nephropathy

BackgroundIgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world and is an important cause of chronic kidney disease (CKD) and kidney failure. Outcomes are heterogeneous, and accurate risk stratification is important to identify the highest risk individuals for treatment and to help prevent disease progression. The Oxford classification (OC) is an internationally adopted standard for renal biopsy reporting in IgAN, which measures the degree of histological abnormalities and predicts prognosis. The kidney failure risk equation (KFRE) was developed to predict kidney failure in all causes of CKD and has been shown to be highly accurate across diverse etiologies. This review aimed to compare the KFRE with formulae incorporating the OC in accurately determining the risk of kidney failure in IgAN.MethodsA systematic review was conducted in accordance with the Cochrane library guidelines and PRISMA statement for reporting of systematic reviews. Studies comparing the accuracy of the KFRE with the OC in predicting disease progression and kidney failure in IgAN were evaluated. The search strategy and analysis were performed independently by two reviewers. Studies that were eligible for inclusion compared the KFRE with any tool incorporating the OC in a cohort of individuals with IgAN. Eligible outcomes were reduction of estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD), and prognostic tools were required to assess the accuracy of these formulae by discrimination and/or calibration.ResultsAfter searching several databases, only one study was eligible for inclusion in the review. This study of 2300 Chinese individuals with IgAN had a median follow-up of 2.5 years. Two-hundred eighty-eight individuals had a composite outcome of 50% decline in eGFR or ESRD, and 214 individuals developed ESRD. Both the KFRE and the IgAN Risk Prediction (IRP) tool (incorporating the OC) were highly accurate at predicting ESRD with a C-statistic of 0.90 and 0.91, respectively. Subgroup analysis demonstrated improved performance of IRP over KFRE in discrimination for individuals with preserved eGFR (> 60 ml/min/1.73 m2) at baseline. The risk of bias was high due to insufficient follow-up and handling of missing data, so overall confidence in findings is very low.ConclusionThere is currently insufficient evidence to compare the accuracy of the KFRE and OC in determining outcomes in IgAN. Further research is required in this field.Systematic review registrationPROSPERO CRD42022364569.

Optimizing Care for Primary Glomerulonephritis: The Role of Thyroid Evaluation.

The coexistence of primary glomerulonephritis and autoimmune thyroid disease has not been investigated. This study aimed to assess thyroid morphology using sonography, determine the prevalence of autoimmune thyroid disorders, and evaluate thyroid function status in patients diagnosed with primary glomerulonephritis. This single-center cross-sectional and observational study included 58 consecutive patients with primary glomerulonephritis and 58 healthy controls (HC). All participants underwent thyroid examination through laboratory tests and thyroid ultrasonography. The findings were subsequently compared between the two groups. Among the patients, 17.2% (n = 10) exhibited subclinical hypothyroidism, while 8.6% (n = 5) had overt hypothyroidism. None of the HCs showed overt hypothyroidism, whereas 3.4% (n = 2) of them exhibited subclinical hypothyroidism. Patients displayed significantly lower free triiodothyronine (FT3) levels than HCs (p < 0.001). A linear correlation was observed between patients' thyroid-stimulating hormone (TSH) levels and the degree of proteinuria (p = 0.044). Furthermore, thyroid volume (p < 0.001), hypoechogenicity (p < 0.001), heterogeneous structure (p < 0.001), pseudonodular hypoechoic infiltration (p = 0.05), and the presence of nodules (p < 0.001) were notably higher in patients compared to HCs. The prevalence of both overt and subclinical hypothyroidism, along with the frequency of nodular goiter, was found to be elevated in patients with primary glomerulonephritis. Considering that primary glomerulonephritis predominantly afflicts young individuals, and these patients bear the lifelong burden of chronic kidney disease, we underscore the significance of routine thyroid function tests and sonographic examinations for the early detection of thyroid disorders.

Associations of Causes of Chronic Kidney Disease with Disease Progression and Mortality: Insights from the Fukuoka Kidney Disease Registry Study

Introduction: The Kidney Disease: Improving Global Outcomes guidelines recognize the importance of causes of chronic kidney disease (CKD), glomerular filtration rate, and albuminuria as predictors of kidney outcome and prognosis. However, compared with biopsy-proven causes, there has been limited research regarding the relationship between clinically diagnosed causes of CKD and patient prognosis. Methods: We examined 3,119 patients with non-dialysis-dependent CKD who participated in the Fukuoka Kidney disease Registry Study, a multicenter prospective cohort study. Patients were divided into six groups: IgA nephropathy, chronic glomerulonephritis (non-biopsy-proven), diabetic nephropathy, hypertensive nephrosclerosis, chronic interstitial nephritis, and polycystic kidney disease. The primary outcomes included a composite kidney outcome, defined as a 1.5-fold increase in serum creatinine and/or the development of end-stage kidney disease, and all-cause mortality. The risks of these outcomes were estimated using a Fine-Gray proportional subdistribution hazards model. Patients with IgA nephropathy, the most prevalent primary glomerulonephritis, served as the reference group. Results: During the median follow-up period of 5 years, 1,221 patients developed the composite kidney outcome, and 346 patients died. Compared with IgA nephropathy, the multivariable-adjusted subdistribution hazard ratios (sHRs) for the composite kidney outcome were significantly higher in diabetic nephropathy (sHR 1.45) and polycystic kidney disease (sHR 2.07) groups, whereas the chronic interstitial nephritis group had a significantly lower risk (sHR 0.71). The risk of all-cause mortality was significantly higher in the hypertensive nephrosclerosis group (sHR 1.90). Conclusion: The causes of CKD were associated with risks of the composite kidney outcome and all-cause mortality, highlighting their clinical relevance in predicting prognosis. These findings suggest that different causes of CKD have distinct impacts on patient outcomes, emphasizing the importance of tailoring management strategies according to the underlying causes.

Nailfold capillaroscopic changes in patients with glomerular diseases.

Nailfold capillaroscopic changes in patients with glomerular diseases.

Biopsy Proven IgA Nephropathy in Children: A Single Center Experience

Introduction: IgA nephropathy is one of the most common primary glomerulonephritis in children and adolescents worldwide. IgA nephropathy is present with symptoms ranging from recurrent asymptomatic hematuria to gross hematuria, nephrotic syndrome and rapid decline in renal function. MEST-C scoring system identified various histopathological variables. Objectives: Aim of this study was to find out the presentation at time of diagnosis of IgA nephropathy and determine the histopathological finding with crescent according to the Oxford classification of IgA nephropathy. Methods: This was a cross-sectional study conducted in Kanti Children’s Hospital from 2012 to 2023. All 28 children below 14 years of age diagnosed with biopsy proven IgA nephropathy were included in the study. Henoch schonlein purpura and systemic lupus erythematosus were excluded from the study. Demographic information, such as age, gender, mode of presentation, and histological findings were recorded. Result: A total 28 children were analyzed with male preponderances 16 (57.1%). IgA nephropathy was more common in age group 11 to 14 years. Among children with IgA nephropathy 21 (75%) had gross hematuria and 14 children had hypertension (50%). According to MEST classification maximum number of children had E1 and T2, 22 (78.57%) and 21 (75%) respectively. Crescent was found in 17 (60.71%) cases. Conclusion: Children with IgA nephropathy gross hematuria is most common presentation and crescents are also common in renal biopsies.

Treatment of chronic kidney disease in IgA nephropathy

This article provides an overview of treatment approaches for chronic kidney disease (CKD) in patients with IgA nephropathy (IgAN). IgAN is the most common primary glomerulonephritis and results from an autoimmune reaction to aberrantly glycosylated immunoglobulin A (IgA) antibodies. Although historically considered largely benign, it is now recognized that a significant percentage of patients develop dialysis-dependent kidney disease over the years. Traditional treatments with RAAS inhibitors and newer therapies such as SGLT2 inhibitors, endothelin receptor antagonists, and delayed release, primarily locally acting enteric corticosteroids regarding their role in reducing proteinuria and preserving kidney function are also discussed. Additionally, non-immunosuppressive options and lifestyle modifications are examined for their potential to slow disease progression. Further promising medications are currently in clinical trials, including complement inhibitors and immunomodulators. These emerging therapies offer hope for significantly improving the prognosis of IgAN in the future. By presenting a comprehensive overview of current and potential future treatment strategies, this review aims to provide clinicians with up-to-date information to optimize the management of CKD in patients with IgAN.

Which Immunosuppressive Therapy should be used in Primary Membranous Glomerulonephritis?

Background: Different results have been reported on immunosuppressive treatments in patients with primary membranous nephropathy. In recent years, it has been determined that antiPLA2R antibodies can be used for the diagnosis of primary membranous glomerulonephritis. The aim of this study was to investigate the treatment responses of patients with primary membranous glomerulonephritis determined by the presence of PLA2-R antibody. Patients and Methods: Sixty patients (M:29, F:31) with membranous glomerulonephritis were retrospectively investigated. The presence of glomerular PLA2R antibodies were investigated by immunohistochemical method from the pathological specimen. Those patients were treated with immunosuppressants (methylprednisolon, cyclophosphamide, cyclosporine, azathioprine), and angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB). The treatments were carried out with different combinations. The success of the treatment was defined as complete (&lt;0.3g/day), partial (&lt;3.5g/day or at least 50% reduction) or unresponsive (insufficient reduction) according to the reduction in proteinuria. In the patients, progression risks (low, moderate, high) were divided according to proteinuria and creatinine clearance. The results of immunosuppressive treatments were statistically analyzed, and p&lt;0.05 was accepted significant. Results Glomerular PLA2R antibodies were positive in 50 cases (87.7%), negative in 7 cases (12.2%). The mean duration of treatment of the patients was 23 months (6-58 months). With the treatment of PLA2R antibody-positive patients, 29% developed complete remission, 56% partial remission, and 15% did not respond. Complete remission was achieved only by steroid plus cyclophosphamide or cyclosporine combinations. The overall response (complete plus partial) rates were similar (respectively, 91% and 89%) in cyclophosphamide or cyclosporine treatment with steroids. The reduction rates in proteinuria were 70.6% in patients using cyclophosphamide, steroid, and ARB, and 79.5% in patients using cyclosporine, steroid, and ARB; there was no difference between them (P=0.67). In patients with positive PLA2R antibodies, the risk of progression was low in 25%, moderate in 29%, and high in 46%. When the treatment responses were examined, a lower rate of complete remission and higher partial remission were found in the high-risk group than in the low-risk group. However, overall response rates were not different in risk groups. Conclusion In primary membranous glomerulonephritis, only cyclophosphamide or combinations of cyclosporine and steroids provided complete remission. The complete plus partial response rates were similar in all risk groups.

Evaluation of the Prognostic Value of Inflammatory Biomarkers in Immunoglobulin A Nephropathy

Aim: Immunoglobulin A (IgA) nephropathy, the most prevalent primary glomerulonephritis, carries the potential for progression to kidney failure. The researches are going on for biomarkers that can be used to predict the prognosis. This study aimed to evaluate the effect of some inflammatory parameters on prognosis in IgA nephropathy. Materials and Methods: The study included 53 patients diagnosed with IgA nephropathy. Blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), urinary microprotein/creatinine (Mp/Cr) ratio, white blood cell count (WBC), mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), erythrocyte sedimentation rate (ESR), and C-Reactive protein (CRP) at initial admission, along with eGFR values at subsequent follow-ups (1, 3, and 5 years), were retrospectively analyzed. Poor prognosis was defined as a 50% or greater reduction in eGFR, hemodialysis requirement, kidney transplantation, or exitus. Results: Patients with poor prognosis exhibited higher BUN, creatinine, and Mp/Cr ratio, accompanied by lower eGFR levels. Notably, among the inflammatory biomarkers, only MPV demonstrated a significant difference between the prognosis groups, with lower values observed in the poor prognosis group (p=0.006). ROC analysis revealed significant predictive value for all five parameters (BUN, creatinine, eGFR, urine Mp/Cr and MPV), with MPV showing the highest AUC value (0.78). Conclusion: This study pioneers the evaluation of MPV as a prognostic marker in IgA nephropathy. Pending confirmation through subsequent investigations, MPV holds promise as a valuable prognostic indicator for IgA nephropathy.