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"Associated" or "Secondary" IgA nephropathy? An outcome analysis
Bogdan Obrișcă1,2, Gabriel Ștefan2,3, Mihaela Gherghiceanu2,4
1Nephrology Department, Fundeni Clinical Institute, Bucharest, Romania.
Plos One
|August 10, 2019
Summary
Primary and secondary IgA nephropathy (sIgAN) show minimal outcome differences, with sIgAN not predicting disease progression. Viral infections and lower eGFR worsen prognosis in sIgAN patients, while immunosuppression shows no effect.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- IgA nephropathy (IgAN) is classified as primary (pIgAN) or secondary (sIgAN).
- Uncertainty exists regarding outcome disparities between pIgAN and sIgAN.
- sIgAN is often associated with specific conditions like liver disease or viral infections.
Purpose of the Study:
- To investigate and compare the clinical outcomes of primary IgA nephropathy (pIgAN) and secondary IgA nephropathy (sIgAN).
- To identify predictors of kidney disease progression in patients with IgAN.
- To evaluate the impact of underlying conditions on sIgAN prognosis.
Main Methods:
- Retrospective observational study of 306 IgAN patients (2010-2017).
- Propensity score matching used to compare sIgAN and pIgAN groups with similar progression risks.
- Kaplan-Meier and Cox regression analyses performed to assess the composite endpoint (kidney function decline or death).
Main Results:
- sIgAN patients were older with more comorbidities but had similar MESTC scores and eGFR as pIgAN patients.
- No significant difference in the composite endpoint was observed between sIgAN and pIgAN groups in unmatched or matched analyses.
- Higher mortality was noted in sIgAN patients (19% vs. 3%).
- Within sIgAN, viral infections and lower eGFR were associated with worse prognosis.
Conclusions:
- The clinical outcomes and MESTC scores between pIgAN and sIgAN are largely similar.
- "Associated IgA nephropathy" may be a more fitting term than "secondary IgA nephropathy".
- Immunosuppressive therapy did not demonstrate a significant impact on the outcomes of sIgAN.
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