D'Amico et al identified risk factors for progression to renal failure in a patient with idiopathic IgA mesangial nephropathy. These can help identify a patient who may benefit from more aggressive management. The authors are fro, the University of Milan and multiple hospitals in Milan, Italy.
Endpoint was renal "death", which was defined as either:
(1) serum creatinine > 10 mg/dL
(2) initiation of regular dialysis treatments
Independent risk factors at time of initial biopsy identified on multivariate analysis:
(1) proteinuria > 1 gram per day
(2) glomerular obsolescence (mild increase in risk if 1 - 20% of glomeruli are obsolescent, significant increase in risk if > 20% are obsolescent)
(3) presence of interstitial fibrosis
(4) extension of IgA deposits into peripheral capillary walls on immunofluorescence (mesangial plus parietal pattern, with overflow of immune deposits from the mesangial area)
If none of these risk factors were present, then renal survival at 5 and 9 years was 100%.
If all 4 risk factors (including > 20% glomerular obsolescence) were present, then renal survival at 5 years was 32% and at 9 years was 10% (see Table 3, page 369)..
|
Percent Obsolescent Glomeruli |
Interstitial Sclerosis |
Heavy Proteinuria |
Extended IgA Deposits |
9 Year Renal Survival |
|
0 |
N |
N |
N |
100% |
|
0 |
N |
N |
Y |
100% |
|
0 |
N |
Y |
N |
100% |
|
0 |
N |
Y |
Y |
100% |
|
0 |
Y |
N |
N |
97% |
|
0 |
Y |
N |
Y |
97% |
|
0 |
Y |
Y |
N |
97% |
|
0 |
Y |
Y |
Y |
92% |
|
1 - 20% |
N |
N |
N |
97% |
|
1 - 20% |
N |
N |
Y |
97% |
|
1 - 20% |
N |
Y |
N |
97% |
|
1 - 20% |
N |
Y |
Y |
95% |
|
1 - 20% |
Y |
N |
N |
92% |
|
1 - 20% |
Y |
N |
Y |
85% |
|
1 - 20% |
Y |
Y |
N |
82% |
|
1 - 20% |
Y |
Y |
Y |
67% |
|
> 20% |
N |
N |
N |
92% |
|
> 20% |
N |
N |
Y |
85% |
|
> 20% |
N |
Y |
N |
82% |
|
> 20% |
N |
Y |
Y |
67% |
|
> 20% |
Y |
N |
N |
62% |
|
> 20% |
Y |
N |
Y |
37% |
|
> 20% |
Y |
Y |
N |
32% |
|
> 20% |
Y |
Y |
Y |
10% |
from Table 3, page 369
Nonindependent risk factors:
(1) Arterial hyalinosis is a risk factor that correlates with glomerular obsolesence (page 374).
(2) Arterial hypertension (> 150/95 mm Hg) was associated with progression to renal failure (page 373).
(3) Diffuse mesangial proliferation/hypercellularity was associated with greater risk than focal mesangial proliferation which was associated with greater risk than minimal mesangial proliferation (Figure 3, page 368).
(4) No macroscopic hematuria was associated with greater risk than isolated macroscopic hematuris which was associated with greater risk than recurrent macroscopic hematuria (Figure 1, page 367)
Specialty: Nephrology, Clinical Laboratory, Immunology/Rheumatology
