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1.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35443440

RESUMO

Diabetes mellitus (DM) is the leading cause of chronic kidney disease worldwide chiefly attributable to diabetic nephropathy (DN). In these patients, non diabetic kidney disease (NDKD) can also occur either alone or superimposed on diabetic nephropathy. This study aimed to identify the prevalence and the etiology of NDKD in our center and also the clinical and laboratory parameters to help distinguish these two entities. MATERIAL: This was a cross sectional observational study. A total of 47 patients were enrolled in the study during the study period. In all the patients, kidney biopsy was done because of atypical presentations and was examined by light and immunofluorescence microscopy. The clinical & laboratory parameters and the biopsy findings were recorded in a standard proforma. OBSERVATION: A total of 47 patients (male/female: 34/13 and mean age 52.11±9.36) were included in the study. The chief co morbidity was hypertension which was present in 61.7% of patients. The most common indication of biopsy was nephrotic presentation (38.3%) followed by nephritic illness (25.5%). The prevalence of NDKD in our study cohort was 85.1% of which isolated NDKD was 57.4% and NDKD + DN was 27.7%. The most common histological lesion were membranous glomerulopathy and focal segmental glomerulosclerosis (FSGS) each with a frequency of 15% followed by chronic tubulointerstitial nephritis (CTIN), IgA nephropathy and others. There was significant difference in the median duration of diabetes in these groups and it was around 5 years less in the NDKD group. There was no difference among three groups in term of eGFR, HbA1C and proteinuria. CONCLUSION: Our study demonstrated a high prevalence of NDKD in the patients with type 2 diabetes. The duration of diabetes was the strongest predictor of NDKD. Kidney biopsy should be undertaken liberally whenever there is strong clinical suspicion especially in the presence of atypical features. The exact histological diagnosis can clarify the further treatment planning as well as the prognosis.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Glomerulonefrite por IGA , Nefropatias , Adulto , Biópsia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Feminino , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite por IGA/patologia , Humanos , Rim/patologia , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Proteinúria , Estudos Retrospectivos
3.
J Clin Lab Anal ; 36(1): e24120, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34783399

RESUMO

PURPOSE: The purpose of our study was to investigate the relationship between serum fibrinogen value and renal tubular atrophy/interstitial fibrosis in immunoglobulin A nephropathy patients with eGFR ≥90 ml/min/1.73 m2 . PATIENTS AND METHODS: Of 359 patients diagnosed with immunoglobulin A nephropathy after renal biopsy were enrolled in this retrospective study. Demographic, histopathological features, and clinical data were collected. The relationships among these factors were analyzed by using Student's t test, Mann-Whitney U test, Kruskal-Wallis test, Chi-square test, or Fisher's exact test, where appropriate. The logistic regression analysis was performed to examine the independent risk factors. RESULTS: Of 176 immunoglobulin A nephropathy patients with eGFR ≥90 ml/min/1.73 m2 were included in this study, and patients were classified into low fibrinogen (fibrinogen <304.6 mg/dl) and high fibrinogen (fibrinogen ≥304.6 mg/dl) groups, respectively. High fibrinogen groups had advanced age, a higher classification of renal tubular atrophy/interstitial fibrosis, and higher levels of systolic pressure, D-dimer, 24 h urine protein quantitation, nag enzyme. Multivariate logistic analysis showed that fibrinogen (OR = 1.018) was significantly associated with tubular atrophy/interstitial fibrosis. CONCLUSION: Among patients with immunoglobulin A nephropathy, the higher levels of fibrinogen and uric acid may mean a higher score of tubular atrophy/interstitial fibrosis, which suggests the renal biopsy should be performed for these patients as early as possible to defined pathological classification, even though there is no obvious abnormal change in the test of renal function.


Assuntos
Fibrinogênio/análise , Fibrose/patologia , Glomerulonefrite por IGA , Túbulos Renais/patologia , Adulto , Atrofia , Feminino , Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite por IGA/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Úrico/sangue , Adulto Jovem
4.
Nephrol Dial Transplant ; 37(4): 749-759, 2022 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-34788864

RESUMO

BACKGROUND: IgA nephropathy (IgAN) is the most common primary glomerulonephritis affecting all ages and both sexes, but there is a lack of studies on its association with cancer and whether it is a paramalignant condition. METHODS: In a Swedish population-based cohort study we compared the risk of cancer among 3882 biopsy-verified IgAN patients diagnosed during 1974-2011 with 19 341 reference individuals and followed them until 2015. Cox regression was used to estimate hazard ratios (HRs) for cancer in IgAN patients versus controls and conditional logistic regression assessed the risk of cancer before the IgAN was confirmed. RESULTS: During a median follow-up of 12.6 years, 488 (12.6%) patients with IgAN and 1783 (9.2%) matched reference individuals were diagnosed with cancer {HR 1.70 [95% confidence interval (CI), 1.52-1.89]}. The increased risk was only seen in IgAN patients developing end-stage renal disease (ESRD), with an HR of 4.01 (95% CI 3.33-4.82) for any cancer and HR of 2.22 (95% CI 1.79-2.75) when excluding non-melanoma skin cancer (NMSC). Non-ESRD IgAN patients did not have an increased overall cancer risk [HR 1.13 (95% CI 0.99-1.30)]. There was no increased risk of cancer preceding an IgAN diagnosis [odds ratio 1.10 (95% CI 0.92-1.32)]. CONCLUSIONS: We found no support for IgAN being a paramalignant condition. There was an increased risk of cancer in IgAN patients, but only for those with ESRD. Our results indicate ∼6 extra cancer cases per 100 IgAN patients with ESRD per 10 years, or >17 extra cases if including NMSC as well.


Assuntos
Glomerulonefrite por IGA , Falência Renal Crônica , Neoplasias , Estudos de Coortes , Progressão da Doença , Feminino , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/epidemiologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/etiologia , Masculino , Neoplasias/complicações , Neoplasias/epidemiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia
5.
Nephrol Dial Transplant ; 37(3): 531-539, 2022 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-33416845

RESUMO

BACKGROUND: Little is known about clinical characteristics and kidney outcomes in patients with biopsy-proven immunoglobulin A nephropathy (IgAN) in a context of inflammatory bowel disease (IBD). METHODS: We conducted a retrospective multicentre study with a centralized histological review to analyse the presentation, therapeutic management and outcome of 24 patients suffering from IBD-associated IgAN relative to a cohort of 134 patients with primary IgAN without IBD. RESULTS: Crohn's disease and ulcerative colitis accounted for 75 and 25% of IBD-associated IgAN cases, respectively. IBD was diagnosed before IgAN in 23 cases (a mean of 9 years previously) and was considered active at IgAN onset in 23.6% of patients. Hypertension was present in 41.7% of patients. The urinary protein:creatinine ratio exceeded 100 mg/mmol in 70.8% of patients (mean 254 mg/mmol). Estimated glomerular filtration rate (eGFR) was >60 mL/min/1.73 m2 in 13/24 patients and only 1 patient required dialysis. In the Oxford mesangial hypercellularity, endocapillary cellularity, segmental sclerosis and interstitial fibrosis/tubular atrophy with crescents classification of renal biopsies, 57% were M1, 48% E1, 76% S1, 57% T1-2 and 38% C1-2. Steroids were administered in 50% of cases. After a mean follow-up of 7.2 years, 4 patients (16.7%) had a poor kidney outcome: end-stage renal disease (n = 3) or a >50% decrease in eGFR from initial values (n = 1). A similar evolution was observed in patients with primitive IgAN. CONCLUSIONS: This first case series suggests that IBD-associated IgAN has frequent inflammatory lesions at onset and variable long-term outcomes.


Assuntos
Glomerulonefrite por IGA , Doenças Inflamatórias Intestinais , Biópsia , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/epidemiologia , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/patologia , Rim , Estudos Multicêntricos como Assunto , Diálise Renal , Estudos Retrospectivos
6.
Korean J Intern Med ; 37(1): 146-153, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32872745

RESUMO

BACKGROUND/AIMS: Hypertension is considered a risk factor in immunoglobulin A nephropathy (IgAN). However, after IgAN diagnosis, the relationship between early blood pressure control and renal prognosis remains unclear. This study aimed to analyze the association between the prognosis of IgAN patients and a controlled status of hypertension within the first year of IgAN diagnosis. METHODS: We retrospectively analyzed 2,945 patients diagnosed with IgAN by renal biopsy. The patients were divided into 'normal,' 'new-onset,' 'well-controlled,' and 'poorly-controlled' groups using blood pressure data from two consecutive measurements performed within a year. The Kaplan-Meier survival analysis and Cox proportional-hazards regression model were used to survey the independent association between recovery from hypertension and the risk of IgAN progression. The primary endpoint was IgAN progression defined as the initiation of dialysis or kidney transplantation. RESULTS: Before IgAN diagnosis, 1,239 patients (42.1%) had been diagnosed with hypertension. In the fully adjusted Cox proportional-hazards models, the risk of IgAN progression increased by approximately 1.7-fold for the prevalence of hypertension. In the subgroup analyses, the 'well-controlled' group showed a statistically significant risk of IgAN progression (hazard ratio [HR], 3.19; 95% confidence interval [CI], 1.103 to 9.245; p = 0.032). Moreover, the 'new-onset' and 'poorly-controlled' groups had an increased risk of IgAN progression compared to the 'normal' group (HR, 2.58; 95% CI, 1.016 to 6.545; p = 0.046 and HR, 3.85;95% CI, 1.541 to 9.603; p = 0.004, respectively). CONCLUSION: Although hypertension was well-controlled in the first year after IgAN diagnosis, it remained a risk factor for IgAN progression.


Assuntos
Glomerulonefrite por IGA , Hipertensão , Falência Renal Crônica , Progressão da Doença , Feminino , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/epidemiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco
7.
Front Immunol ; 12: 753901, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34721428

RESUMO

We aimed to validate three IgAN risk models proposed by an international collaborative study and another CKD risk model generated by an extended CKD cohort with our multicenter Chinese IgAN cohort. Biopsy-proven IgAN patients with an eGFR ≥15 ml/min/1.73 m2 at baseline and a minimum follow-up of 6 months were enrolled. The primary outcomes were a composite outcome (50% decline in eGFR or ESRD) and ESRD. The performance of those models was assessed using discrimination, calibration, and reclassification. A total of 2,300 eligible cases were enrolled. Of them, 288 (12.5%) patients reached composite outcome and 214 (9.3%) patients reached ESRD during a median follow-up period of 30 months. Using the composite outcome for analysis, the Clinical, Limited, Full, and CKD models had relatively good performance with similar C statistics (0.81, 0.81, 0.82, and 0.82, respectively). While using ESRD as the end point, the four prediction models had better performance (all C statistics > 0.9). Furthermore, subgroup analysis showed that the models containing clinical and pathological variables (Full model and Limited model) had better discriminatory abilities than the models including only clinical indicators (Clinical model and CKD model) in low-risk patients characterized by higher baseline eGFR (≥60 ml/min/1.73 m2). In conclusion, we validated recently reported IgAN and CKD risk models in our Chinese IgAN cohort. Compared to pure clinical models, adding pathological variables will increase performance in predicting ESRD in low-risk IgAN patients with baseline eGFR ≥60 ml/min/1.73 m2.


Assuntos
Glomerulonefrite por IGA/epidemiologia , Adulto , Estudos de Coortes , Creatinina/sangue , Progressão da Doença , Feminino , Seguimentos , Mesângio Glomerular/química , Mesângio Glomerular/patologia , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/patologia , Glucocorticoides/uso terapêutico , Hospitais de Ensino , Humanos , Imunoglobulina A/análise , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Masculino , Microscopia de Fluorescência , Pessoa de Meia-Idade , Modelos Teóricos , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Prognóstico , Proteinúria/etiologia , Curva ROC , Sistema Renina-Angiotensina/efeitos dos fármacos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
8.
J Pak Med Assoc ; 71(8): 1930-1934, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34418003

RESUMO

OBJECTIVE: To study the association of hyperuricaemia with clinical and pathological characteristics of patients with IgA nephropathy, and to clarify adverse effects of hyperuricaemia on the onset and progression of IgA nephropathy. METHODS: A total of 244 patients with IgA nephropathy enrolled in Jiangjin Center Hospital were divided into a group with normal serum uric acid level and a group with elevated level. Age, gender, course of disease, blood pressure, liver function, renal function, blood lipid levels, blood glucose level, 24-hour urine protein level and pathological grades were recorded. The correlations of serum uric acid level with clinical indices and pathological grades were analyzed. RESULTS: The incidence rate of IgA nephropathy complicated with hyperuricaemia was 25.4%. The two groups had significantly different course of disease, body mass index (BMI), and levels of urea nitrogen, creatinine, triglyceride and urine protein (p<0.05). The group with elevated serum uric acid level had higher Lee's grade, tubulointerstitial lesion grade and renal arteriolar lesion grade. Patients with IgA nephropathy were prone to hyperuricaemia, being closely correlated with BMI, course of disease, blood pressure, triglyceride level and renal function. High pathological grades were important indices for poor prognosis. CONCLUSIONS: The serum uric acid levels of patients with IgA nephropathy should be monitored to effectively control hyperuricaemia and to avoid its complications.


Assuntos
Glomerulonefrite por IGA , Hiperuricemia , Creatinina , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/epidemiologia , Humanos , Hiperuricemia/complicações , Hiperuricemia/epidemiologia , Rim , Ácido Úrico
9.
Clin J Am Soc Nephrol ; 16(8): 1247-1255, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34362788

RESUMO

BACKGROUND AND OBJECTIVES: In patients with kidney failure due to IgA nephropathy, IgA deposits can recur in a subsequent kidney transplant. The incidence, effect, and risk factors of IgA nephropathy recurrence is unclear, because most studies have been single center and sample sizes are relatively small. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a multicenter, international, retrospective study to determine the incidence, risk factors, and treatment response of recurrent IgA nephropathy after kidney transplantation. Data were collected from all consecutive patients with biopsy-proven IgA nephropathy transplanted between 2005 and 2015, across 16 "The Post-Transplant Glomerular Disease" study centers in Europe, North America, and South America. RESULTS: Out of 504 transplant recipients with IgA nephropathy, recurrent IgA deposits were identified by kidney biopsy in 82 patients; cumulative incidence of recurrence was 23% at 15 years (95% confidence interval, 14 to 34). Multivariable Cox regression revealed a higher risk for recurrence of IgA deposits in patients with a pre-emptive kidney transplant (hazard ratio, 3.45; 95% confidence interval, 1.31 to 9.17) and in patients with preformed donor-specific antibodies (hazard ratio, 2.59; 95% confidence interval, 1.09 to 6.19). After kidney transplantation, development of de novo donor-specific antibodies was associated with subsequent higher risk of recurrence of IgA nephropathy (hazard ratio, 6.65; 95% confidence interval, 3.33 to 13.27). Immunosuppressive regimen was not associated with recurrent IgA nephropathy in multivariable analysis, including steroid use. Graft loss was higher in patients with recurrence of IgA nephropathy compared with patients without (hazard ratio, 3.69; 95% confidence interval, 2.04 to 6.66), resulting in 32% (95% confidence interval, 50 to 82) graft loss at 8 years after diagnosis of recurrence. CONCLUSIONS: In our international cohort, cumulative risk of IgA nephropathy recurrence increased after transplant and was associated with a 3.7-fold greater risk of graft loss.


Assuntos
Anticorpos/sangue , Glomerulonefrite por IGA/epidemiologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Adulto , Aloenxertos/imunologia , Aloenxertos/patologia , Biópsia , Brasil/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/tratamento farmacológico , Glomerulonefrite por IGA/patologia , Sobrevivência de Enxerto , Humanos , Incidência , Rim/patologia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
10.
Mol Genet Genomics ; 296(4): 1017-1026, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34076728

RESUMO

An autoimmune component has been suggested to play a role in pathogenesis of IgA nephropathy (IgAN). And genetic studies have reported the shared susceptibility loci between IgAN and the prototype autoimmune disease systemic lupus erythematosus (SLE). This study was designed to systemically identify and annotate the shared susceptibility genes between IgAN and SLE. We first conducted an imputation-based genome-wide association analysis in 1180 IgAN cases and 899 controls, 1639 SLE cases and 2410 controls. Then we integrated blood expression quantitative trait loci (eQTL) databases and gene expression data to prioritize the potentially functional genes. The results showed that a total of 1928 SNPs mapping to 14 loci were identified to be shared genes between IgAN and SLE. Conditional analysis prioritized 18 independent SNPs, among which alleles of 4 SNPs in HLA and 7 SNPs in non-HLA loci were risk for SLE were protective alleles for IgAN. Most of the shared SNPs and their proxies (r2 ≥ 0.8 in Asians) (181/184, 98.37%) in non-HLA loci were located in non-coding regions. By analyzing two publicly independent blood-eQTL databases, four genes UBE2L3, FCGR2B, ANXA6, and BLK, which seemed to be restricted to PBMC or its subsets were prioritized. Among them only UBE2L3 showed consistent direction between SLE and IgAN, while the others showed opposite directions. Differential gene analysis showed that UBE2L3 was highly expressed in both SLE and IgAN, while FCGR2B and BLK showed marginal significance in SLE and IgAN, respectively. By exploring the pleiotropy of shared genes between IgAN and SLE, our results provide important clues for understanding the shared role of plasmablasts but the distinct role of B cells in pathogenesis of these two diseases.


Assuntos
Glomerulonefrite por IGA/genética , Lúpus Eritematoso Sistêmico/genética , Adolescente , Adulto , Alelos , Estudos de Casos e Controles , China/epidemiologia , Feminino , Frequência do Gene , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla/métodos , Genótipo , Glomerulonefrite por IGA/sangue , Glomerulonefrite por IGA/epidemiologia , Humanos , Leucócitos Mononucleares/metabolismo , Leucócitos Mononucleares/patologia , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Polimorfismo de Nucleotídeo Único , Locos de Características Quantitativas , Fatores de Risco , Adulto Jovem
11.
Genes Genomics ; 43(9): 1049-1057, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34146253

RESUMO

BACKGROUND: Immunoglobulin A nephropathy (IgAN) is one of the most common primary forms of glomerulonephritis, while IgA vasculitis (IgAV) is the most common systemic vasculitis in children. OBJECTIVE: Herein we aimed to uncover single nucleotide polymorphism (SNP) markers associated with these two related diseases by applying association tests and Sanger sequencing. METHODS: Within the discovery stage, genomic DNA in blood samples from 101 enrolled patients were genotyped by the Korean Biobank Array. Association tests were performed with 397 Korean reference genomes. In the validation stage, 26 independent samples were genotyped by Sanger sequencing. RESULTS: Four SNPs were identified (P < 5 × 10-8) in the discovery stage. To determine whether the genotypes determined by SNP array were accurate, additional genotyping via Sanger sequencing was performed. As a result, only one SNP, rs9428555, was properly genotyped. In the validation stage, the minor allele (A > G) was found in as many as 15 out of 26 samples (minor allele frequency = 0.288), even though this minor allele is rare in East Asians (< 3%). CONCLUSIONS: We found rs9428555 as a novel susceptible locus associated with the development of both IgAN and IgAV in Koreans. Though we cannot conclude rs9428555 is the unique susceptible locus of IgAN and IgAV, it is likely a good marker as the minor allele of this SNP occurred much more often in the patient group here versus within East Asians as a whole.


Assuntos
Doenças Autoimunes/genética , Predisposição Genética para Doença , Glomerulonefrite por IGA/genética , Imunoglobulina A/genética , Transtorno Obsessivo-Compulsivo/genética , Adolescente , Alelos , Doenças Autoimunes/patologia , Criança , Feminino , Frequência do Gene , Estudo de Associação Genômica Ampla , Glomerulonefrite por IGA/epidemiologia , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/patologia , Polimorfismo de Nucleotídeo Único/genética , República da Coreia/epidemiologia
12.
Ann Transplant ; 26: e931873, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-33986240

RESUMO

BACKGROUND Nationwide data on allograft kidney biopsies have been limited in number, in contrast to the large amount of accumulated data on native kidney biopsies. In this context, we have surveyed transplant biopsy data based on the nationwide database, the Japan Renal Biopsy Registry (J-RBR). MATERIAL AND METHODS A total of 2430 transplant biopsy cases were registered in the web-based J-RBR from January 2007 to January 2018. We categorized the entries regarding both the purpose of the biopsy and pathological diagnosis, and confirmed transplant glomerular diseases based on the clinical and pathological diagnosis. RESULTS Of the 2430 total transplant biopsy cases, 637 cases, including 9 cases of baseline biopsy, 216 cases of protocol biopsy, and 232 cases of episode biopsy, had a pathological diagnosis, including glomerular diseases, rejection, calcineurin inhibitor nephropathy, and interstitial fibrosis and tubular atrophy. Of these, 127 cases presented with glomerular disease, including 8 cases of baseline biopsy, 23 of protocol biopsy, 59 of episode biopsy, and 37 of unknown purpose). A total of 127 biopsies with glomerular disease revealed a high prevalence of immunoglobulin A nephropathy (n=38, 29.9%), followed by mesangial proliferative glomerulonephritis (n=29, 22.8%) and focal segmental glomerulosclerosis (n=8, 6.3%) when focused on protocol and episode biopsies. CONCLUSIONS The nationwide transplant biopsy database demonstrated the pathological characteristics of 637 cases, including 127 cases of post-transplant glomerular disease. The protocol and episode biopsies included high prevalence rates of IgAN, followed by FSGS.


Assuntos
Glomerulonefrite por IGA , Transplante de Rim , Adulto , Biópsia , Feminino , Glomerulonefrite por IGA/epidemiologia , Humanos , Japão/epidemiologia , Rim , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
13.
Ren Fail ; 43(1): 851-859, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33970769

RESUMO

PURPOSE: To identify the clinical characteristics, histopathological features, and prognosis of kidney disease in a large cohort of elderly patients from Northeast China. METHODS: We retrospectively analyzed the renal disease spectrum in 7,122 patients who underwent renal biopsies at the Second Hospital of Jilin University from 2006 to 2020. Patients were grouped according to age: below 60 years (non-elderly group, n = 5923) and at least 60 years (elderly group, n = 1199). The clinical and pathological characteristics of renal biopsy patients in the groups were analyzed using the t-test and chi-square test. RESULTS: Compared with the non-elderly group, the elderly group had significantly fewer patients with primary glomerulonephritis, but more patients with tubulointerstitial disorders (p < .05). The incidence of IgA nephropathy, mesangial proliferative glomerulonephritis, and lupus nephritis was significantly lower in elderly patients than in non-elderly patients. The incidence of membranous nephropathy, membranoproliferative glomerulonephritis, diabetic nephropathy, hypertensive nephropathy, systemic vasculitis-associated renal damage, and amyloid nephropathy was significantly higher in elderly patients than in non-elderly patients (p < .05). The incidence of perinephric hematoma (≥4 cm2) in elderly patients with renal biopsy was lower than that in non-elderly patients. We noted that 79.9% of primary glomerulonephritis patients who received immunosuppressive therapy showed a remission rate of 83.5%. CONCLUSION: The spectrum of kidney disease in the elderly is different from that in the younger population.


Assuntos
Biópsia , Glomerulonefrite/epidemiologia , Hipertensão Renal/epidemiologia , Nefrite/epidemiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/patologia , Feminino , Glomerulonefrite/patologia , Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite por IGA/patologia , Glomerulonefrite Membranoproliferativa/epidemiologia , Glomerulonefrite Membranoproliferativa/patologia , Glomerulonefrite Membranosa/epidemiologia , Glomerulonefrite Membranosa/patologia , Humanos , Hipertensão Renal/patologia , Incidência , Rim/patologia , Nefrite Lúpica/epidemiologia , Nefrite Lúpica/patologia , Masculino , Pessoa de Meia-Idade , Nefrite/patologia , Estudos Retrospectivos
14.
Clin Exp Nephrol ; 25(9): 1018-1026, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34047871

RESUMO

BACKGROUND: Only a few studies have investigated epidemiological and clinicopathological information regarding pediatric and adolescent and young adult (AYA) patients with renal disease. The purpose of this study was to clarify the differences and relationship of clinicopathological findings between pediatric and AYA patients using the Japan Renal Biopsy Registry (J-RBR). METHODS: This cross-sectional study analyzed data from patients registered in the J-RBR between 2007 and 2017. Clinicopathological findings at diagnosis were analyzed for 3,463 pediatric (age < 15 years) and 6,532 AYA (age 15-30 years) patients. RESULTS: Although chronic nephritic syndrome was the most common clinical diagnosis at age > 5 years, nephrotic syndrome was the most frequent diagnosis at age < 4 years. The most common pathological diagnosis as classified by pathogenesis in pediatric patients was primary glomerular disease (except IgA nephropathy), whereas IgA nephropathy was increased in AYA patients. Mesangial proliferative glomerulonephritis was the most common pathological diagnosis as classified by histopathology in both pediatric and AYA patients. Minor glomerular abnormalities were the most frequent histopathologic diagnoses of nephrotic syndrome in childhood, but their frequency decreased with age. CONCLUSION: To the best of our knowledge, this is the first report of clinicopathological features of pediatric and AYA patients in a large nationwide registry of renal biopsy. There were differences of clinical, pathological and histopathologic findings between pediatric and AYA patients.


Assuntos
Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite Membranoproliferativa/epidemiologia , Síndrome Nefrótica/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Biópsia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/patologia , Glomerulonefrite Membranoproliferativa/patologia , Humanos , Lactente , Japão/epidemiologia , Glomérulos Renais/patologia , Masculino , Síndrome Nefrótica/patologia , Proteinúria/epidemiologia , Proteinúria/patologia , Sistema de Registros , Adulto Jovem
15.
BMC Nephrol ; 22(1): 165, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952193

RESUMO

BACKGROUND: Chronic kidney disease has been linked to cardiovascular disease and specifically ischemic heart disease (IHD), but large-scale population data in patients with immunoglobulin A nephropathy (IgAN) are missing. OBJECTIVE: To examine absolute and relative risks for IHD in patients with IgAN. METHODS: Population-based register-based cohort study in Sweden. We identified 3945 patients with biopsy-verified IgAN, and 19,272 age- and sex-matched reference individuals from the general population. To reduce residual confounding from genetic factors and early environmental factors we carried out secondary analyses, where we compared 3039 IgAN patients with 6729 siblings, whereas a spousal analysis consisted of 2377 married couples where one of the spouses had IgAN. Data on IHD and end-stage renal disease (ESRD) were retrieved from the nationwide Patient Register. Cox regression estimated hazard ratios (HRs) adjusted for matching variables, education, country of birth, cancer, diabetes mellitus, and other systemic inflammatory diseases. RESULTS: During a follow-up of 55,527 person-years (py; mean follow-up 14.1 years), 371 patients (9.4%) with IgAN developed IHD (6.7/1000 py), compared with 1070 (5.6%) in 287,677 py in reference individuals (3.7/1000 py). The corresponding adjusted HR was 1.86 (95%CI = 1.63-2.13), equivalent to one extra case of IHD per 34 IgAN patients followed-up for 10 years. HRs were similar in men and women with IgAN, but higher in the first year after diagnosis and in patients born outside the Nordic countries. Patients with IgAN were at increased risk of IHD also compared to siblings (HR = 2.07; 95%CI = 1.62-2-64) and spouses (HR = 1.91; 95%CI = 1.40-2.61). CONCLUSIONS: In this nationwide population-based study, patients with IgAN were at an 86% increased risk of future IHD.


Assuntos
Glomerulonefrite por IGA/epidemiologia , Isquemia Miocárdica/epidemiologia , Adolescente , Adulto , Comorbidade , Feminino , Glomerulonefrite por IGA/complicações , Fatores de Risco de Doenças Cardíacas , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Isquemia Miocárdica/complicações , Modelos de Riscos Proporcionais , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
16.
Clin Exp Nephrol ; 25(6): 621-632, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33646451

RESUMO

BACKGROUND: Clinicopathological significance of light chain deposition in IgA nephropathy and the relation of monotypic IgA deposition to bone marrow abnormalities are important issues to be clarified. METHODS: We retrospectively investigated light chain deposition in 526 patients with IgA nephropathy. We divided the patients into 5 groups according to the balance of intensity of both light chain deposition: lambda monotypic, lambda dominant, polytypic, kappa dominant and kappa monotypic. Clinicopathological parameters were compared among the groups. The relation of monotypic IgA deposition to hematological malignancy was also evaluated. RESULTS: The prevalence of monotypic IgA deposition was 6.3%, 33 patients (21 lambda and 12 kappa). Thirty-two (4.0%) and 10 patients (1.9%) were classified into lambda and kappa dominant groups, respectively. Polytypic IgA deposition was observed in 455 patients (85.7%). Age of onset, age at biopsy, urinary protein creatinine ratio, the percentage of global glomerulosclerosis, and the degree of IgA and C3 deposition were different among the groups. However, there was no gradual difference according to the groups. No patient with monotypic IgA deposition showed hematological abnormality at biopsy and during follow-up. CONCLUSIONS: The prevalence of IgA monotypic deposition was extremely low. Clinicopathologically, we could not differentiate patients with monotypic IgA deposition from those with polytypic one and no hematological disorder was documented in patients with monotypic IgA deposition. Whether IgA nephropathy with monotypic IgA deposition and that with polytypic one is the same entity or not, and relation between monotypic IgA deposition and hematological malignancy should be clarified by further investigations.


Assuntos
Glomerulonefrite por IGA/imunologia , Imunoglobulina A/análise , Cadeias kappa de Imunoglobulina/análise , Cadeias lambda de Imunoglobulina/análise , Rim/imunologia , Adolescente , Adulto , Biópsia , Complemento C3/análise , Feminino , Imunofluorescência , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/epidemiologia , Humanos , Japão/epidemiologia , Rim/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Adulto Jovem
17.
Ren Fail ; 43(1): 488-499, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33685345

RESUMO

Background: The relationship between hematuria, a typical presentation of immunoglobulin A nephropathy (IgAN), and long-term adverse prognosis of these patients is still controversial. This meta-analysis aims to clarify the effect of hematuria on renal outcomes in IgAN.Methods: Observational cohort studies reporting associations between various forms of hematuria and renal outcomes among IgAN patients were identified from the PubMed and Embase databases. The pooled adjusted risk ratios (RRs) were computed with random effects models.Results: Thirteen studies encompassing 5660 patients with IgAN were included. Patients with initial hematuria did not have a significantly increased risk of developing end-stage renal disease (ESRD) compared with those without hematuria (RR, 1.32; 95% CI, 0.87-2.00; p = .19). However, initial microscopic hematuria was associated with an 87% increase in the risk of ESRD (RR, 1.87; 95% CI, 1.40-2.50; p < .001), while macroscopic hematuria was associated with a 32% decrease in the risk of ESRD (RR, 0.68; 95% CI, 0.58-0.79; p < .001). Additionally, persistent hematuria might be an independent risk factor for ESRD or a 50% decline in eGFR.Conclusions: Among IgAN patients, hematuria, including initial microscopic hematuria and even persistent hematuria, was possibly associated with renal progression and ESRD. However, independent of other classical predictors, initial macroscopic hematuria might be a protective factor for IgAN.


Assuntos
Progressão da Doença , Glomerulonefrite por IGA/epidemiologia , Hematúria/epidemiologia , Falência Renal Crônica/epidemiologia , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/diagnóstico , Hematúria/diagnóstico , Humanos , Falência Renal Crônica/diagnóstico , Fatores de Risco
18.
J Nephrol ; 34(5): 1591-1598, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33683676

RESUMO

BACKGROUND: Immunoglobulin A nephropathy (IgAN) incidence peaks in childbearing age. Data on pregnancy outcomes in women with IgAN are limited. METHODS: We performed a register-based cohort study in a nationwide cohort of women with biopsy-verified IgAN in Sweden, comparing 327 pregnancies in 208 women with biopsy-verified IgAN and 1060 pregnancies in a matched reference population of 622 women without IgAN, with secondary comparisons with sisters to IgAN women. Adverse pregnancy outcomes, identified by way of the Swedish Medical Birth Register, were compared through multivariable logistic regression and presented as adjusted odds ratios (aORs). Main outcome was preterm birth (< 37 weeks). Secondary outcomes were preeclampsia, small for gestational age (SGA), low 5-min Apgar score (< 7), fetal or infant loss, cesarean section, and gestational diabetes. RESULTS: We found that IgAN was associated with an increased risk of preterm birth (13.1% vs 5.6%; aOR = 2.69; 95% confidence interval [CI] = 1.52-4.77), preeclampsia (13.8% vs 4.2%; aOR = 4.29; 95%CI = 2.42-7.62), SGA birth (16.0% vs 11.1%; aOR = 1.84; 95%CI = 1.17-2.88), and cesarean section (23.9% vs 16.2%; aOR = 1.74, 95%CI = 1.14-2.65). Absolute risks were low for intrauterine (0.6%) or neonatal (0%) death and for low 5-min Apgar score (1.5%), and did not differ from the reference population. Sibling comparisons suggested increased risks of preterm birth, preeclampsia, and SGA in IgAN, but not of cesarean section. CONCLUSION: We conclude that although most women with IgAN will have a favorable pregnancy outcome, they are at higher risk of preterm birth, preeclampsia and SGA. Intensified supervision during pregnancy is warranted.


Assuntos
Glomerulonefrite por IGA , Nascimento Prematuro , Cesárea , Estudos de Coortes , Feminino , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/epidemiologia , Humanos , Lactente , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia
19.
Sci Rep ; 11(1): 3584, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574388

RESUMO

The Oxford classification of IgA nephropathy (IgAN) can evaluate each MEST-C score individually. We analysed a new grading system that utilised the total MEST-C score in predicting renal prognosis. Altogether, 871 IgAN patients were classified into three groups using the new Oxford classification system (O-grade) that utilised the total MEST-C score (O-grade I: 0-1, II: 2-4, and III: 5-7 points), and the 10-year renal prognosis was analysed. The clinical findings became significantly severer with increasing O-grades, and the renal survival rate by the Kaplan-Meier method was 94.1%, 86.9%, and 74.1% for O-grades I, II, and III, respectively. The hazard ratios (HRs) for O-grades II and III with reference to O-grade I were 2.8 (95% confidence interval [CI] 1.3-6.0) and 6.3 (95% CI 2.7-14.5), respectively. In the multivariate analysis, mean arterial pressure and eGFR, proteinuria at the time of biopsy, treatment of corticosteroids/immunosuppressors, and O-grade (HR 1.63; 95% CI 1.11-2.38) were the independent factors predicting renal prognosis. Among the nine groups classified using the O-grade and Japanese clinical-grade, the renal prognosis had an HR of 15.2 (95% CI 3.5-67) in the severest group. The O-grade classified by the total score of the Oxford classification was associated with renal prognosis.


Assuntos
Glomerulonefrite por IGA/diagnóstico , Falência Renal Crônica/diagnóstico , Rim/patologia , Adulto , Biópsia , Progressão da Doença , Feminino , Taxa de Filtração Glomerular/fisiologia , Glomerulonefrite por IGA/classificação , Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite por IGA/patologia , Humanos , Estimativa de Kaplan-Meier , Rim/diagnóstico por imagem , Falência Renal Crônica/classificação , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Fatores de Tempo
20.
Int Urol Nephrol ; 53(2): 315-323, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32944891

RESUMO

AIM: The aim of this study was to explore the effect of sex on the clinicopathological features and long-term outcomes of IgAN patients. METHODS: A total of 1096 adult IgAN patients were divided into male and female groups. Clinicopathological features and risk factors of IgAN patients of different genders were contrasted. The primary endpoint was the combined endpoint of a 50% reduction in estimated glomerular filtration rate (eGFR) and/or end stage renal disease (ESRD: eGFR < 15 mL/min/1.73 m2 or dialysis). The effect of gender on prognosis of IgAN was assessed using Kaplan-Meier and Cox proportional hazards models. RESULTS: In total, 475 male patients and 621 female patients were included in this study. At baseline, male patients had higher values for blood pressure, serum creatinine, urine protein and serum uric acid, as well as lower levels of eGFR. Further analysis indicated that tubular atrophy/interstitial fibrosis (T) lesions and vascular lesions were more frequent in male patients. During the follow-up period of 40.9 ± 24.2 months, kidney survival rates of male IgAN patients were remarkably lower than those of female patients. Using multivariate Cox regression analysis, male gender was identified as an independent risk factor for poor outcomes (ß = 0.384, Wald = 4.290, Exp (ß) = 1.47, p = 0.038), including hypertension, low eGFR, IgM deposition, arteriosclerosis lesions and T1-T2 lesions. However, male and female patients were characterized by different risk factors. CONCLUSION: Male patients presented with more severe clinical and pathological changes than female patients. Renal survival rates of male patients were remarkably lower than those of female patients, and male gender was identified as an independent risk factor for poor outcomes.


Assuntos
Glomerulonefrite por IGA/diagnóstico , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite por IGA/fisiopatologia , Humanos , Falência Renal Crônica/etiologia , Masculino , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
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