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Clinicopathological Characteristics and Prognostic Factors of Asymptomatic IgA Nephropathy
  1. Pei-Cheng Shen, MS*†,
  2. Li-Qun He, MD*†,
  3. Ying Tang, MS*,
  4. Qing Wang, MS*,
  5. Wei Wang, MS*,
  6. Jie Li, MS*
  1. From the *Department of Nephrology, Traditional Chinese Internal Medicine e-Institute of Shanghai University, ShuGuang Hospital, Shanghai University of Traditional Chinese Medicine; and †Key Laboratory of Liver and Kidney Diseases, Shanghai University of Traditional Chinese Medicine, Ministry of Education, Shanghai, PR China.
  1. Received April 25, 2009, and in revised form December 18, 2009.
  2. Accepted for publication December 18, 2009.
  3. Reprints: Li-Qun He, MD, 528 ZhangHeng Rd, Department of Nephrology, ShuGuang Hospital, Pudong, Shanghai 201203, PR China; E-mail: spc720216{at}yahoo.com.cn.
  4. Supported by the National Natural Science Foundation of China (grant 30873259), Shanghai Excellent Academic Leaders Project (grant 08XD14039), e-Institute of TCM Internal Medicine of Shanghai Municipal Education Commission (grant E03008), the project of Shanghai Municipal Health Bureau (2007114), and the Creative Team Program of the Shanghai Municipal Education Commission.
  5. This work is not under active consideration for publication, has not been accepted for publication, and has not been published. There are no conflicts of interest and ethical adherence.

Abstract

Aims Many patients with immunoglobulin class A (IgA) nephropathy (IgAN) present with asymptomatic urinary abnormalities. The purpose of this study was to observe the clinicopathological characteristics and prognostic factors in asymptomatic IgAN.

Methods Eighty-six asymptomatic IgAN patients (49 males and 37 females) were investigated; 82 of them were followed up during a mean ± SD period of 66.7 ± 19.7 months.

Results At biopsy, 18 patients (21%) presented with pure hematuria (HU), 29 patients (34%) presented with proteinuria alone (PU), and 39 patients (45%) presented concomitant hematuria and proteinuria with severe pathological lesions. Meanwhile, 16% and 26% had renal insufficiency and hypertension, respectively. Finally, urinary abnormalities of 15% of the patients disappeared, 25% of HU developed proteinuria, 47% of concomitant hematuria and proteinuria, and 32% of PU appeared to have increase of proteinuria, and 14% of PU developed hematuria. Fifteen (24%) of the patients with normal blood pressure initially became hypertensive and 18 (22%) of the patients with normal renal function initially developed renal insufficiency. Twenty-four patients (29%) had doubling of serum creatinine level, and 13 patients (16%) progressed to end-stage renal disease. Prednisone therapy and antihypertensive treatment significantly improved proteinuria and renal function deterioration. Hematuria, hypertension during follow-up, and tubulointerstitial lesions were independent risk factors predictive of the ultimate development of renal progression.

Conclusions The renal outcome of asymptomatic IgAN is guarded. Hematuria, hypertension during follow-up, and tubulointerstitial lesions may be important markers to monitor renal progression in the course.

Key Words
  • IgA nephropathy
  • asymptomatic urinary abnormalities
  • hypertension
  • pathological findings
  • renal progression
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