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Survival in idiopathic glomerulonephritis
Abstract:
Actuarial survival was studied in 285 adult patients with idiopathic glomerulonephritis (GN). Minimum follow-up was 7 years. 105 patients had minimal change GN (MC), 22 membranous GN (MGN), 20 acute GN (AGN), 11 mesangial sclerosis Gn (MSGN), 28 mesangiocapillary GN (MCGN), 8 crescentic GN (RPGN), 27 unclassifiable GN, 61 focal proliferative GN (FGN), and 3 focal segmental glomerular sclerosis and hyalinosis (FSGSH). Ten year survival was best in FGN (91%), and progressively poorer in MC (90%), AGN (85%), MSGN (83%), MGN (82%), MCGN (62%), unclassifiable GN (37%), and RPGN (16%). One of the three patients with FSGSH died during follow-up. At 10 years, survival differed significantly (p less than 0.01) from expected only in MCGN, RPGN and unclassifiable GN. Our results suggest that -- because survival was not significantly different from expected in most types of GN -- the current classification of GN is only a crude guide to prognosis. The nephrotic syndrome was found to worsen prognosis in MGN and MCGN.
Insights
Actuarial survival in idiopathic glomerulonephritis (GN) varied by type. Most GN classifications showed survival similar to the general population, suggesting current classifications are crude prognostic guides.
Area of Science:
- Nephrology
- Clinical Epidemiology
Background:
- Idiopathic glomerulonephritis (GN) encompasses diverse kidney diseases with variable prognoses.
- Accurate prognostic indicators are crucial for managing GN patients.
Purpose of the Study:
- To evaluate actuarial survival rates across different histological types of idiopathic GN.
- To assess the prognostic value of the current GN classification system.
Main Methods:
- Retrospective analysis of actuarial survival in 285 adult patients with idiopathic GN.
- Minimum follow-up of 7 years, with 10-year survival rates calculated for various GN subtypes.
Main Results:
- Ten-year survival was highest in focal proliferative GN (91%) and lowest in rapidly progressive GN (16%).
- Survival differed significantly from expected only in mesangiocapillary GN, unclassifiable GN, and rapidly progressive GN.
- Nephrotic syndrome adversely affected prognosis in membranous GN and mesangiocapillary GN.
Conclusions:
- The current classification of idiopathic GN offers a limited guide to prognosis, as survival is often not significantly different from the general population.
- Further refinement of prognostic markers beyond histological type is warranted for idiopathic GN.