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Clinicopathological characteristics of patients with immunoglobulin A nephropathy showing acute exacerbations after favorable long-term clinical courses.
Tanaka, Mai; Miyazaki, Yoichi; Koike, Kentaro; Ueda, Hiroyuki; Tsuboi, Nobuo; Hirano, Keita; Okonogi, Hideo; Ogura, Makoto; Kawamura, Tetsuya; Yokoo, Takashi.
Affiliation
  • Tanaka M; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
  • Miyazaki Y; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan. yoichimiyazaki@jikei.ac.jp.
  • Koike K; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
  • Ueda H; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
  • Tsuboi N; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
  • Hirano K; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
  • Okonogi H; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
  • Ogura M; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
  • Kawamura T; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
  • Yokoo T; Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
Clin Exp Nephrol ; 20(2): 226-34, 2016 Apr.
Article in En | MEDLINE | ID: mdl-26289088
ABSTRACT

BACKGROUND:

Sometimes, acute and progressive proteinuria increases occur in patients with IgA nephropathy (IgAN) after favorable long-term clinical courses of >10 years, but their clinical and histological characteristics are not well understood.

METHODS:

We retrospectively selected 20 IgAN patients who had been followed for >10 years after their initial biopsies ((1st)Bx) and underwent second biopsies ((2nd)Bx), because their proteinuria increased to >1 g/day. Eight patients with acute exacerbations (Group A) showed acute proteinuria increases after long periods of mild proteinuria. Their clinicopathological characteristics were analyzed as a case series and were compared with those in Group B that comprised 12 patients with persistent proteinuria.

RESULTS:

Group A experienced acute proteinuria increases and significant hematuria increases compared with the -1-year (P = 0.006) and -3-year (P = 0.010) time points before the (2nd)Bx, which contrasted to the clinical course in Group B. In Group A, glomerulosclerosis (GS) and the arteriosclerosis score did not differ between the (2nd)Bx and the (1st)Bx, and most patients (88 %) showed cellular and/or fibrocellular crescents within the (2nd)Bx. Compared with Group B, the (2nd)Bx revealed that the percentage of cellular and/or fibrocellular crescents (P = 0.001) was significantly higher, whereas the percentage of GS (P = 0.012) and the arteriosclerosis score (P = 0.020) were significantly lower in Group A.

CONCLUSION:

Rapid proteinuria and hematuria increases, and acute histological lesions characterize acute exacerbations in IgAN after favorable long-term clinical courses.
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Full text: 1 Database: MEDLINE Main subject: Proteinuria / Glomerulonephritis, IGA / Kidney Type of study: Observational_studies / Prognostic_studies Limits: Adult / Child / Female / Humans / Male / Middle aged Language: En Journal: Clin Exp Nephrol Journal subject: NEFROLOGIA Year: 2016 Type: Article Affiliation country: Japan

Full text: 1 Database: MEDLINE Main subject: Proteinuria / Glomerulonephritis, IGA / Kidney Type of study: Observational_studies / Prognostic_studies Limits: Adult / Child / Female / Humans / Male / Middle aged Language: En Journal: Clin Exp Nephrol Journal subject: NEFROLOGIA Year: 2016 Type: Article Affiliation country: Japan