IgA nephropathy natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
==Natural History== | ==Natural History== | ||
The clinical course of IgA nephropathy varies widely between patients. Although it is generally regarded as a benign disease, emerging data has shown that progression to ESRD and death are more common than originally believed.<ref name="pmid15882273">{{cite journal| author=Haubitz M, Wittke S, Weissinger EM, Walden M, Rupprecht HD, Floege J et al.| title=Urine protein patterns can serve as diagnostic tools in patients with IgA nephropathy. | journal=Kidney Int | year= 2005 | volume= 67 | issue= 6 | pages= 2313-20 | pmid=15882273 | doi=10.1111/j.1523-1755.2005.00335.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15882273 }} </ref> Some patients rapidly progress into ESRD; but the majority experience a stable kidney function following diagnosis.<ref name="pmid15882273">{{cite journal| author=Haubitz M, Wittke S, Weissinger EM, Walden M, Rupprecht HD, Floege J et al.| title=Urine protein patterns can serve as diagnostic tools in patients with IgA nephropathy. | journal=Kidney Int | year= 2005 | volume= 67 | issue= 6 | pages= 2313-20 | pmid=15882273 | doi=10.1111/j.1523-1755.2005.00335.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15882273 }} </ref> | |||
Commonly, the progression of IgA nephropathy is slower than other notorious glomerular disease. Approximately 20-30% of patients with IgA nephropathy progress to ESRD after 10 years<ref name="pmid15882273">{{cite journal| author=Haubitz M, Wittke S, Weissinger EM, Walden M, Rupprecht HD, Floege J et al.| title=Urine protein patterns can serve as diagnostic tools in patients with IgA nephropathy. | journal=Kidney Int | year= 2005 | volume= 67 | issue= 6 | pages= 2313-20 | pmid=15882273 | doi=10.1111/j.1523-1755.2005.00335.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15882273 }} </ref> and up to 30-50% of patients develop ESRD over 20 years.<ref name="pmid3445013">{{cite journal| author=Velo M, Lozano L, Egido J, Gutierrez-Millet V, Hernando L| title=Natural history of IgA nephropathy in patients followed-up for more than ten years in Spain. | journal=Semin Nephrol | year= 1987 | volume= 7 | issue= 4 | pages= 346-50 | pmid=3445013 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3445013 }} </ref><ref name="pmid9048338">{{cite journal| author=Radford MG, Donadio JV, Bergstralh EJ, Grande JP| title=Predicting renal outcome in IgA nephropathy. | journal=J Am Soc Nephrol | year= 1997 | volume= 8 | issue= 2 | pages= 199-207 | pmid=9048338 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9048338 }} </ref> | |||
==Complications== | ==Complications== | ||
*[[Acute nephritic syndrome]] or [[nephrotic syndrome]] | *[[Acute nephritic syndrome]] or [[nephrotic syndrome]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
The clinical course of IgA nephropathy varies widely between patients. Although it is generally regarded as a benign disease, emerging data has shown that progression to ESRD and death are more common than originally believed.[1] Some patients rapidly progress into ESRD; but the majority experience a stable kidney function following diagnosis.[1] Commonly, the progression of IgA nephropathy is slower than other notorious glomerular disease. Approximately 20-30% of patients with IgA nephropathy progress to ESRD after 10 years[1] and up to 30-50% of patients develop ESRD over 20 years.[2][3]
Complications
Prognosis
Male gender, proteinuria (especially > 2 g/day), hypertension, smoking, hyperlipidemia, older age, familial disease and elevated creatinine concentrations are markers of a poor outcome. Frank hematuria has shown discordant results with most studies showing a better prognosis, perhaps related to the early diagnosis, except for one group which reported a poorer prognosis. Proteinuria and hypertension are the most powerful prognostic factors in this group[2]. There are certain other features on kidney biopsy such as interstitial scarring which are associated with a poor prognosis. ACE gene polymorphism has been recently shown to have an impact with the DD genotype associated more commonly with progression to renal failure.
References
- ↑ 1.0 1.1 1.2 Haubitz M, Wittke S, Weissinger EM, Walden M, Rupprecht HD, Floege J; et al. (2005). "Urine protein patterns can serve as diagnostic tools in patients with IgA nephropathy". Kidney Int. 67 (6): 2313–20. doi:10.1111/j.1523-1755.2005.00335.x. PMID 15882273.
- ↑ Velo M, Lozano L, Egido J, Gutierrez-Millet V, Hernando L (1987). "Natural history of IgA nephropathy in patients followed-up for more than ten years in Spain". Semin Nephrol. 7 (4): 346–50. PMID 3445013.
- ↑ Radford MG, Donadio JV, Bergstralh EJ, Grande JP (1997). "Predicting renal outcome in IgA nephropathy". J Am Soc Nephrol. 8 (2): 199–207. PMID 9048338.