Stratifying risk for progression in IgA nephropathy: how to predict the future?

Area of Science:

• Nephrology
• Immunology
• Pathology

Background:

• IgA nephropathy (IgAN) presents a heterogeneous clinical course, complicating prognosis assessment and treatment strategies.
• Identifying reliable risk factors is crucial for managing IgAN progression.

Purpose of the Study:

• To define risk factors for IgAN progression.
• To evaluate histopathological features (Oxford classification and non-Oxford findings) and clinical data for prognostic value.

Main Methods:

• Single-center retrospective study of 52 patients with biopsy-proven IgAN.
• Endpoint: 50% increase in serum creatinine from baseline.
• Analysis included baseline and follow-up clinical data and biopsy findings.

Main Results:

• Eight patients (12%) reached the endpoint.
• Independent predictors of poor renal outcome: proteinuria >2.0 g/d, eGFR <60 ml/min/1.73 m², tonsillectomy history, and crescent lesions.
• Global sclerosis index, proteinuria, and hematuria predicted faster eGFR decline.

Conclusions:

• Proteinuria and baseline renal function are significant clinical prognostic factors in IgAN.
• Non-Oxford histopathological features, including global sclerosis index and crescents, aid in IgAN risk stratification.