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Prognostic factors in immunoglobulin-A nephropathy
T Muthukumar1, M E Fernando, M Jayakumar
1Department of Nephrology, Government General Hospital, Chennai, Tamil Nadu.
The Journal of the Association of Physicians of India
|February 14, 2003
Summary
Immunoglobulin-A nephropathy (IgA-N) patients with high serum creatinine, specific kidney damage (Hass-V, crescents), and interstitial fibrosis face a higher risk of end-stage renal failure (ESRF). Early detection and intervention are crucial for better outcomes.
Area of Science:
- Nephrology
- Internal Medicine
- Pathology
Background:
- Immunoglobulin-A nephropathy (IgA-N) is a primary glomerular disease.
- Understanding its progression to end-stage renal failure (ESRF) is critical for patient management.
Purpose of the Study:
- To investigate the clinical course of IgA-N.
- To identify prognostic factors for ESRF development in adults with IgA-N.
- To develop a predictive model for ESRF in IgA-N.
Main Methods:
- Retrospective cohort study.
- Involved 98 adult patients diagnosed with primary IgA-N.
- Data collected on clinical presentation, renal lesions, and follow-up for ESRF development.
Main Results:
- 61% of patients presented with renal failure at diagnosis.
- Factors predicting ESRF progression included serum creatinine > 5 mg/dl, Hass subclass V histology, crescents, and interstitial fibrosis.
- Five-year renal survival was 38.5%; median ESRF-free survival decreased significantly with increasing risk factors.
Conclusions:
- Serum creatinine > 5 mg/dl, crescents, Hass-V histology, and interstitial fibrosis are significant predictors of ESRF progression in IgA-N.
- Detailed assessment of the tubulointerstitium in renal biopsies is recommended for improved prognostication.