Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome☆
Section snippets
Outcome: actuarial renal survival
Despite the relative paucity of relevant symptoms during the clinical course, the outcome is extremely variable and difficult to predict, as we1 and other2 have already emphasized many years ago. Some patients who presented with an episode of macroscopic hematuria, after 40 years and dozens of recurrences of the macroscopic hematuria still have a normal renal function and in repeat biopsies, after the four decades, show only mesangial proliferation with scarce segmental glomerular sclerosis or
Clinical, histologic, and genetic prognostic factors in adults and children
Among the numerous studies on the clinical and histologic predictors of an unfavorable outcome in adult patients with IgAN, we selected, according to the criteria previously mentioned, 23 studies in which an univariate analysis of the various risk factors, each independently considered, has been performed, usually comparing renal survival rates calculated according to the method of Kaplan and Meyer. A multivariate survivorship analysis of the prognostic factors that had appeared more
Can we predict the ultimate outcome for the single patients?
All nephrologists with extensive experience will agree that some patients with rather marked proteinuria and/or severe histologic lesions at the time of biopsy could have rather favorable courses, and some patients with moderate proteinuria and/or mild histologic lesions could have progressive courses in the following years.
Even when some impairment of renal function has already developed and glomerular sclerosis is severe, the speed of progression to ESRF is quite variable. Before the time of
Conclusion
Three clinical features, when present at the time of diagnosis, are strong predictors of an unfavorable outcome: marked proteinuria, arterial hypertension, and impairment of renal function. The latter is in most instances more a marker of advanced, already progressing renal disease than a true marker of bad prognosis of IgAN. However, even marked proteinuria and arterial hypertension are rather nonspecific markers of severity, valid for all glomerular diseases, as already stressed by us.89
It
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Supported in part by EU Grant OLG1-CT-2002-01215 and by the Associazione per la Ricerca in Nefrologia.