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Microangiopathic Lesions in IgA Nephropathy: A Cohort Study
- Source :
- American Journal of Kidney Diseases. 74:629-639
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Renal arteriolar microangiopathic lesions may occur in immunoglobulin A nephropathy (IgAN), but their role in disease progression remains unclear. We sought to understand the prevalence and character of microangiopathic lesions in IgAN and their role in disease progression.A retrospective cohort study.In this study, we enrolled a Chinese cohort with 944 adult patients with IgAN who had been followed up for at least 1 year.Renal arteriolar microangiopathic lesions.Composite kidney end point event defined as a50% reduction in estimated glomerular filtration rate, end-stage kidney disease, or death.All kidney biopsies were independently reviewed by 2 investigators. Renal arteriolar microangiopathic lesions were detected using light microscopy. Multivariable Cox regression analysis was used to test the association between microangiopathic lesions and the outcomes.Overall, 194 (20.6%) patients had renal arteriolar microangiopathic lesions. Patients with microangiopathic lesions presented with higher blood pressures, more severe proteinuria, and lower estimated glomerular filtration rates (all P0.001) than patients without microangiopathic lesions. After a median follow-up of 4.2 years, 75 (38.7%) patients with microangiopathic lesions and 83 (11.1%) patients without these lesions reached the composite kidney end point (P0.001). In a multivariable Cox regression model adjusting for clinical and pathologic variables available at the time of biopsy, the presence of microangiopathic lesions was an independent risk factor for kidney failure (HR, 1.95; 95% CI, 1.34-2.83; P0.001). Renal vascular sclerosis (arterial intimal fibrosis or arteriolar hyalinosis) was not a risk factor for kidney disease progression (P = 0.5).A single Chinese center's experience, retrospective study, most patients were not tested for hemolytic markers (for example, haptoglobin level, lactate dehydrogenase level, and schistocytes).Renal arteriolar microangiopathic lesions are frequent in IgAN and their presence is independently associated with progression to kidney failure. If confirmed in other patient cohorts, such lesions could be considered for inclusion in formal classification schemes of IgAN.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Biopsy
030232 urology & nephrology
Renal function
Kidney
urologic and male genital diseases
Gastroenterology
Nephropathy
03 medical and health sciences
Renal Artery
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
Retrospective Studies
Proteinuria
business.industry
Glomerulonephritis, IGA
Retrospective cohort study
medicine.disease
Schistocyte
Arterioles
medicine.anatomical_structure
Microscopy, Fluorescence
Renal pathology
Nephrology
Disease Progression
Female
medicine.symptom
business
Follow-Up Studies
Glomerular Filtration Rate
Kidney disease
Subjects
Details
- ISSN :
- 02726386
- Volume :
- 74
- Database :
- OpenAIRE
- Journal :
- American Journal of Kidney Diseases
- Accession number :
- edsair.doi.dedup.....d7753097217a467a8ce2c221c983d9f8