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Lv Y, Fu R, Peng XJ, Wang Y, Yin TT, Deng YQ. Comparative study on clinicopathological features and prognosis of IgA vasculitis nephritis and IgA nephropathy in children. BMC Pediatr 2023; 23:423. [PMID: 37620917 PMCID: PMC10464207 DOI: 10.1186/s12887-023-04243-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND IgA vasculitis nephritis (IgAVN) and IgA nephropathy (IgAN) share several clinical and pathological characteristics, though distinctions also exist. Their interrelation, however, remains undefined. This study investigates the clinicopathological divergences and prognostic disparities in pediatric patients with IgAVN and IgAN. METHODS Our study encompasses 809 pediatric patients with IgAVN and 236 with IgAN, all of whom underwent kidney biopsy. We utilized the Semiquantitative Classification (SQC) scoring system to juxtapose the pathologies of the two conditions, and performed a COX regression analysis to examine factors influencing their prognoses. RESULTS Both patient groups demonstrated a predominance of males. A seasonality was observed, with a higher incidence of IgAN in the summer, and IgAVN in the fall (P < 0.0001). Patients with IgAN exhibited more severe tubulointerstitial injury, higher chronicity index, and total biopsy scores compared to those with IgAVN (P < 0.0001). Mesangial deposition intensity of complement C3, and the rate of pure IgA deposition, were found to be greater in patients with IgAVN compared to those with IgAN (P < 0.0001). The intensity of IgA deposition was also significantly higher in IgAVN patients (P = 0.003). IgAVN demonstrated a superior prognosis, with a higher rate of kidney remission (P < 0.0001). COX regression analysis indicated that interstitial fibrosis, as identified in the SQC pathology system, was associated with the prognosis of both conditions. Furthermore, the findings suggest that IgA deposition levels (IgA + + and IgA + + +) could potentially influence the prognosis of IgAVN. CONCLUSIONS Compared to IgAVN, IgAN manifests more severely with regard to renal impairment, interstitial damage, and prognosis. The disparities in immune complex deposition levels and locations within the kidneys support the hypothesis of IgAVN and IgAN as distinct diseases. Interstitial fibrosis may serve as a key pathological indicator within the SQC system associated with kidney prognosis in children with IgAVN and IgAN. The degree of IgA deposition could also be linked with the prognosis of IgAVN.
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Affiliation(s)
- Yan Lv
- Department of Nephrology, Jiangxi Provincial Children's Hospital, Nanchang, China
- Nanchang University, Nanchang, Jiangxi Province, China
| | - Rui Fu
- Department of Nephrology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Xiao-Jie Peng
- Department of Nephrology, Jiangxi Provincial Children's Hospital, Nanchang, China.
| | - Ying Wang
- Nanchang University, Nanchang, Jiangxi Province, China
| | - Ting-Ting Yin
- Nanchang University, Nanchang, Jiangxi Province, China
| | - Yan-Qing Deng
- Nanchang University, Nanchang, Jiangxi Province, China
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Kifer N, Bulimbasic S, Sestan M, Held M, Kifer D, Srsen S, Gudelj Gracanin A, Heshin-Bekenstein M, Giani T, Cimaz R, Gagro A, Frković M, Coric M, Jelusic M. Semiquantitative classification (SQC) and Oxford classifications predict poor renal outcome better than The International Study of Kidney Disease in Children (ISKDC) and Haas in patients with IgAV nephritis: a multicenter study. J Nephrol 2023; 36:441-449. [PMID: 36447124 DOI: 10.1007/s40620-022-01509-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/19/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Several histologic classifications are used in the evaluation of IgA vasculitis nephritis (IgAVN), however, to date, no studies have determined which one has the strongest association with the severity of IgAVN and, as a consequence, its outcomes. MATERIALS AND METHODS Patients included in the study were diagnosed with IgAV and IgAVN in seven tertiary university medical centers in Croatia, Italy and Israel. The International Study of Kidney Disease in Children (ISKDC), Haas, Oxford, and Semiquantitative classification (SQC) classifications were used in the analysis and description of renal biopsy. Time from biopsy to outcome evaluation was a statistically significant factor in outcome prediction that was used to define the base model, and was a covariate in all the tested models. RESULTS Sixty-seven patients were included in this study. The SQC classification proved to be the best one in outcome prediction, followed by the Oxford classification. The ISKDC and Haas classifications could not predict renal outcome. The Oxford parameters for mesangial hypercellularity and tubular atrophy, as well as the SQC parameters for cellular crescents showed an independent statistically significant contribution to outcome prediction. High level of twenty-four hour protein excretion was associated with a higher grade in the Oxford, SQC and ISKDC classifications. Endocapillary proliferation was positively associated with the Pediatric Vasculitis Activity Score (PVAS) at diagnosis, while tubular atrophy was negatively associated. CONCLUSION The SQC, followed by the Oxford classification were found to provide the best classifications of renal biopsy analysis in patients to predict the outcome in patients with IgAVN. Cellular crescents, mesangial hypercellularity and tubular atrophy showed significant contributions, indicating that active and chronic variables should be included in the estimation.
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Affiliation(s)
- Nastasia Kifer
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Stela Bulimbasic
- Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mario Sestan
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Martina Held
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Domagoj Kifer
- Department of Biophysics, University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Sasa Srsen
- Division of Rheumatology and Immunology, Department of Paediatrics, University of Split School of Medicine, University Hospital Centre Split, Split, Croatia
| | - Ana Gudelj Gracanin
- Department of Internal Medicine, Clinical Hospital Holly Spirit, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Merav Heshin-Bekenstein
- Pediatric Rheumatology Service, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Teresa Giani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- ASST Pini-CTO, Milan, Italy
| | - Alenka Gagro
- Children's Hospital Zagreb, University of Osijek, Medical Faculty Osijek, Osijek, Croatia
| | - Marijan Frković
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Marijana Coric
- Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marija Jelusic
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
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Marques Dias J, Ferreira MA, Grilo A, Gonçalves FM. IgA vasculitis with severe renal manifestation. BMJ Case Rep 2022; 15:e248686. [PMID: 35672051 PMCID: PMC9174811 DOI: 10.1136/bcr-2021-248686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/04/2022] Open
Abstract
IgA vasculitis is a rare systemic vasculitis in adults, frequently more severe than in paediatric age. It manifests with cutaneous, articular, gastrointestinal and renal involvement.We present a case of a man in his 40s diagnosed with IgA vasculitis with cutaneous, joint, gastrointestinal and renal disease. Significant proteinuria and renal biopsy findings demonstrating crescentic glomerulonephritis led to the onset of early immunosuppression with corticoid and cyclophosphamide. This case report reflects a case of more severe renal impairment due to IgA vasculitis with good outcome with the chosen therapy. The findings in the renal biopsy after treatment supported the good response to the chosen immunosuppression.
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Affiliation(s)
| | | | - Ana Grilo
- Internal Medicine, Hospital Beatriz Angelo, Loures, Lisboa, Portugal
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He M, Li C, Kang Y, Zuo Y, Duo L, Tang W. Clinical predictive model for the 1-year remission probability of IgA vasculitis nephritis. Int Immunopharmacol 2021; 101:108341. [PMID: 34775367 DOI: 10.1016/j.intimp.2021.108341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Early remission of Immunoglobulin A vasculitis nephritis (IgAVN) substantially affects its prognosis. In this work, a multivariate model to predict the 1-year remission probability of patients with IgAVN was developed on the basis of clinical laboratory data. METHODS Data of 187 patients with IgAVN confirmed by renal biopsy were retrospectively assessed. Least absolute shrinkage and selection operator regression analysis were conducted to establish a multivariate logistic regression model. A nomogram based on the multivariate logistic regression model was constructed for easy application in clinical practice. Concordance index, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and clinical impact curves (CIC) were used to evaluate the predictive accuracy and clinical value of this nomogram. RESULTS The predictive factors contained in the multivariate model included duration, gender, respiratory infection, arthritis, edema, estimated glomerular filtration rate, 24 h urine protein, uric acid, and renal ultrasound intensity. The area under the curves (AUC) of the nomogram in the training set and testing set were 0.814 and 0.822, respectively, indicating its good predictive ability. Moreover, the DCA curve and CIC revealed its clinical utility. CONCLUSION The developed multivariate predictive model combines the clinical and laboratory factors of patients with IgAVN and is useful in the individualized prediction of the 1-year remission probability aid for clinical decision-making during treatment and management of IgAVN.
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Affiliation(s)
- Manrong He
- Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guoxue alley, Chengdu, Sichuan Zipcode: 610000, China
| | - Chao Li
- Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guoxue alley, Chengdu, Sichuan Zipcode: 610000, China
| | - Yingxi Kang
- Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guoxue alley, Chengdu, Sichuan Zipcode: 610000, China
| | - Yongdi Zuo
- Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guoxue alley, Chengdu, Sichuan Zipcode: 610000, China
| | - Lijin Duo
- Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guoxue alley, Chengdu, Sichuan Zipcode: 610000, China
| | - Wanxin Tang
- Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guoxue alley, Chengdu, Sichuan Zipcode: 610000, China.
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Peruzzi L, Coppo R. IgA vasculitis nephritis in children and adults: one or different entities? Pediatr Nephrol 2021; 36:2615-2625. [PMID: 33219450 DOI: 10.1007/s00467-020-04818-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
The clinical features of the kidney involvement in immunoglobulin A (IgA) vasculitis (IgAVN) differ in children and adults for both clinical presentation and progression. IgAVN in children has mostly a self-limiting course and favorable resolution, while in adults the kidney involvement is frequently severe with unfavorable outcome. However, a subset of children is at risk of progression within the pediatric age or decades later in adulthood, particularly when the diagnosis and a prompt intervention are delayed. Factors predicting progression and outcome in the whole spectrum of age have been investigated in recent research, as well as the relationship between IgAVN and primary IgAN, which share the same pathology features, in the light of peculiar clinical differences and progression tendencies, and hence need for selective treatments. The search for a personalized treatment in children with IgAV and in different ages of life should rely on the identification of different risks for progression. This review will focus on recent studies which contribute to improve our knowledge in this still largely unclear area.
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Affiliation(s)
- Licia Peruzzi
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy.,Pediatric Nephrology Unit, Regina Margherita Department, City of Health and Science University Hospital, Turin, Italy
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy.
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Sugimoto H, Yamaguchi Y, Yumura W, Takei T. Efficacy and safety of low-dose corticosteroid with azathioprine in the treatment of elderly-onset IgA vasculitis with nephritis. BMJ Case Rep 2021; 14:14/6/e241422. [PMID: 34083191 DOI: 10.1136/bcr-2020-241422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The diagnosis of elderly-onset IgA vasculitis (IgAV) and its prognosis can be difficult to ascertain because of its rarity and the frequent presence of comorbidities. Furthermore, the treatment of elderly-onset IgAV remains controversial. We report a case of IgAV in an 87-year-old patient. Renal involvement was detected early during the IgAV follow-up. He was treated with low-dose corticosteroid and azathioprine, which led to a complete remission without any adverse effects. This suggests that precise intervention with early diagnosis and careful renal follow-up may prevent renal failure and that low-dose steroids with azathioprine can be an effective treatment for elderly-onset IgAV with nephritis.
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Affiliation(s)
- Hikaru Sugimoto
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Japan
| | - Yasuko Yamaguchi
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Japan
| | - Wako Yumura
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Japan
| | - Takashi Takei
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Japan
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Luo X, Tan J, Wan D, Chen J, Hu Y. Predictability of the Oxford classification of IgA nephropathy in Henoch-Schonlein purpura nephritis. Int Urol Nephrol 2021; 54:99-109. [PMID: 33905044 DOI: 10.1007/s11255-021-02861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Whether the Oxford classification of immunoglobulin A nephropathy can be utilized to predict the adverse renal outcome of Henoch-Schonlein purpura nephritis (HSPN) has been long-debated. We, therefore, performed a meta-analysis to evaluate the prognostic value of Oxford classification lesions in HSPN. METHODS We systematically searched Medline, EMBASE, Web of Science, and the Cochrane Library for articles published from January 1970 to August 2020. Cohort and case-control studies investigating the correlation between the Oxford classification and renal outcome were included, the quality of which was assessed by the Newcastle-Ottawa scale criteria. The pooled odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated with a random-effects model or a fixed-effects model depending on the heterogeneity. RESULTS A total of 485 papers were reviewed and eventually 9 comparisons were included, providing data of 1688 patients with HSPN. ORs for adverse renal events were 2.83 (95% CI 1.84-4.35; P < 0.001), 1.96 (95% CI 1.28-2.98; P < 0.05), and 5.45 (95% CI, 3.15-9.45; P < 0.001) for patients with lesions of endocapillary hypercellularity (E), segmental sclerosis (S), and tubular atrophy /interstitial fibrosis (T), respectively, without significant heterogeneity (E: I2 = 0.0%; P = 0.498; S: I2 = 22.4%; P = 0.258; T: I2 = 33.6%; P = 0.171). Subgroup analysis adjusted for age also supported the results that E, S, and T lesions could serve as poor predictors (P < 0.05). Additionally, crescents (C) were strongly associated with renal outcome (OR 2.22; 95% CI 1.62-3.04; P < 0.001), with moderate heterogeneity (I2 = 49.3%; P = 0.066). However, it should be noted that it is not the presence but the proportions of crescent lesions that were related to the high risk of progression to adverse renal events, because the predictability of lower rates of crescent (C1, with crescents > 0 and ≤ 25%) was uncertain (OR 2.21; 95% CI 0.75-6.51; P > 0.05). Although the pooled OR revealed that lesions of mesangial hypercellularity (M) were correlated with poor renal prognosis (OR 2.41; 95% CI 1.07-5.43; P < 0.05), subgroup analysis separating children from adults indicated that there seemed to be no significant difference. CONCLUSIONS Oxford classification, especially for E, S, T, and C, might be recommended for patients with HSPN, regardless of children and adults.
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Affiliation(s)
- Xinyao Luo
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jiaxing Tan
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Dingyuan Wan
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Junda Chen
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yahong Hu
- General Hospital of Western Theater Command of the Chinese People's Liberation Army, Chengdu, China.
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Yun D, Kim DK, Oh KH, Joo KW, Moon KC, Kim YS, Lee K, Han SS. MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis. BMC Nephrol 2020; 21:33. [PMID: 32000703 PMCID: PMC6993338 DOI: 10.1186/s12882-020-1691-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/14/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Henoch-Schönlein purpura nephritis (HSPN), a small-vessel vasculitis, shares renal pathological features with immunoglobulin A nephropathy. Oxford classification of immunoglobulin A nephropathy pathology has been updated to the MEST-C score, but its application in HSPN remains unresolved. METHODS Two hundred and thirteen patients with biopsy-proven HSPN were retrieved from the Seoul National University Hospital between 2000 and 2017. Renal outcome risks (i.e., end-stage renal disease or doubling of serum creatinine) were evaluated according to MEST-C scores after stratification by age: 113 children aged < 18 years (9.2 ± 3.6 years) and 100 adults aged ≥18 years (38.6 ± 18.3 years). We pooled our data with four previous cohort studies in which MEST or MEST-C scores were described in detail. RESULTS Twenty-one child (19%) and 16 adult (16%) patients reached the renal outcome during the median follow-up periods of 12 years and 13 years, respectively (maximum 19 years). In children, M1 and T1/T2 scores revealed worse renal outcomes than did M0 and T0 scores, respectively, whereas the T score was the only factor related to worse outcomes in adult patients after adjusting for multiple clinical and laboratory variables. The pooled data showed that M1, S1, and T1/T2 in children and E1 and T1/T2 in adults were correlated with poorer renal outcomes than those of their counterpart scores. CONCLUSIONS The Oxford classification MEST-C scores can predict long-term renal outcomes in patients with HSPN.
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Affiliation(s)
- Donghwan Yun
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
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Shimamura Y, Maeda T, Nishizawa K, Ogawa Y, Takizawa H. Gastrointestinal bleeding is associated with renal prognosis in adult patients with IgA vasculitis with nephritis. J Gen Fam Med 2019; 21:10-17. [PMID: 31911884 PMCID: PMC6942937 DOI: 10.1002/jgf2.285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/03/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022] Open
Abstract
Background Although the prediction of renal prognosis in patients with IgA vasculitis with nephritis (IgAVN) is important, the association between gastrointestinal bleeding (GIB) and its renal prognosis is unknown. This study investigated the effect of GIB on the progression to end‐stage kidney disease (ESKD) in patients with IgAVN. Methods We compared the clinicopathological findings at diagnosis, therapy, and clinical outcomes between 10 patients with GIB and 20 patients without GIB in 30 patients with IgAVN aged ≥18 years at the renal biopsy. The primary outcome was the incidence of ESKD. Secondary outcomes included clinical remission and all‐cause mortality. The outcomes and factors affecting the progression to ESKD were evaluated using the Kaplan‐Meier method with log‐rank test and Cox proportional hazards models. Results End‐stage kidney disease, clinical remission, and deaths from any related cause occurred in 6, 17, and 2 patients, respectively. In Kaplan‐Meier analyses, the GIB group showed a higher incidence of ESKD (50% vs 5%, P = .003) and a lower incidence of clinical remission (20% vs 75%, P = .003). Although the numbers were not statistically significant, this group tended to have a greater number of deaths than the non‐GIB group (7% vs 0%, P = .07). In a multivariable Cox model adjusted for hypertension and urinary proteinuria, GIB could not demonstrate a significant association with ESKD (hazard ratio, 4.51; 95% confidence interval, 0.39‐52.7; P = .23). Conclusion IgAVN with GIB has worse renal outcome, but GIB does not have a statistically significant association with progression to ESKD.
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Affiliation(s)
| | - Takuto Maeda
- Department of Nephrology Teine Keijinkai Medical Center Sapporo Japan
| | - Keitaro Nishizawa
- Department of Nephrology Teine Keijinkai Medical Center Sapporo Japan
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center Sapporo Japan
| | - Hideki Takizawa
- Department of Nephrology Teine Keijinkai Medical Center Sapporo Japan
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