Advertisement

The natural history of immunoglobulin a nephropathy among patients with hematuria and minimal proteinuria

  • Cheuk-Chun Szeto
    Correspondence
    Requests for reprints should be addressed to Cheuk-Chun Szeto, MbChB, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, China
    Affiliations
    Department of Medicine and Therapeutics and the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong, China
    Search for articles by this author
  • Fernand Mac-Moune Lai
    Affiliations
    Department of Medicine and Therapeutics and the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong, China
    Search for articles by this author
  • Ka-Fai To
    Affiliations
    Department of Medicine and Therapeutics and the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong, China
    Search for articles by this author
  • Teresa Yuk-Hwa Wong
    Affiliations
    Department of Medicine and Therapeutics and the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong, China
    Search for articles by this author
  • Kai-Ming Chow
    Affiliations
    Department of Medicine and Therapeutics and the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong, China
    Search for articles by this author
  • Paul Cheung-Lung Choi
    Affiliations
    Department of Medicine and Therapeutics and the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong, China
    Search for articles by this author
  • Siu-Fai Lui
    Affiliations
    Department of Medicine and Therapeutics and the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong, China
    Search for articles by this author
  • Philip Kam-Tao Li
    Affiliations
    Department of Medicine and Therapeutics and the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong, China
    Search for articles by this author

      Abstract

      Purpose: To determine the natural history of immunoglobulin (Ig) A nephropathy among patients who presented with hematuria and minimal proteinuria, and factors associated with the development of adverse clinical events, such as proteinuria.
      Subjects and methods: In Hong Kong, all patients who present with isolated hematuria are referred for renal biopsy after urologic diseases are ruled out. We reviewed the clinical course of 72 consecutive patients with histologically confirmed IgA nephropathy who presented with hematuria and minimal proteinuria (0.4 g/day or less). All patients were normotensive and had normal renal function at presentation. Adverse events were defined as proteinuria greater than 1 g per day, hypertension, or impaired renal function (serum creatinine level 120 μmol/L or estimated creatinine clearance <70 mL per minute).
      Results: The mean (± SD) age at presentation was 27 ± 8 years; 56 (78%) were female. Nine patients (13%) had grade 2 histologic lesions. During a median follow-up of 7 years, 32 patients (44%) developed adverse events: 24 (33%) developed proteinuria of 1 g per day or more, 19 (26%) became hypertensive, and 5 (7%) developed impaired renal function. Another 30 patients (42%) had persistently abnormal urinalysis examinations. Only 10 patients (14%) had complete resolution of hematuria. The median time for progression from proteinuria (>l g/day) to renal impairment was 84 months (range 56 to 132). In a multivariate analysis, age at presentation (relative risk [RR] per 10 years of age = 2.0; 95% confidence interval [CI], 1.2 to 3.4) and histologic grade (grade 2 versus grade 1, RR = 4.5; 95% CI, 1.7 to 12) were independent predictors of developing an adverse event.
      Conclusions: IgA nephropathy that presents with hematuria and minimal proteinuria is usually a progressive disease. Life-long follow-up with regular monitoring of blood pressure and proteinuria is recommended.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • D’Amico G
        The commonest glomerulonephritis in the world.
        Q J Med. 1987; 245: 709-727
        • Lai F.M
        • Lai K.N
        • Chan K.W
        Pattern of glomerulonephritis in Hong Kong.
        Pathology. 1987; 19: 247-252
        • Alamartine E
        • Sabatier J.C
        • Guerin C
        Prognostic factors in mesangial IgA glomerulonephritis.
        Am J Kidney Dis. 1991; 18: 12-19
        • D’Amico G
        Clinical features and natural history in adults with IgA nephropathy.
        Am J Kidney Dis. 1988; 12: 353-357
        • Rychlik I
        • Andrassy K
        • Waldherr R
        • et al.
        Clinical features and natural history of IgA nephropathy.
        Ann Med Interne (Paris). 1999; 150: 117-126
        • Ibels L.S
        • Gyory A.Z
        • Caterson R.J
        • et al.
        Primary IgA nephropathy.
        Kidney Int. 1997; 61: 67-70
        • Schena F.P
        A retrospective analysis of the natural history of primary IgA nephropathy worldwide.
        Am J Med. 1990; 89: 209-215
        • Galla J.H
        IgA nephropathy.
        Kidney Int. 1995; 47: 377-387
        • D’Amico G
        • Ragni A
        • Gandini E
        • Fellin G
        Typical and atypical natural history of IgA nephropathy.
        Contrib Nephrol. 1993; 104: 6-13
        • Hogg R.J
        Usual and unusual presentations of IgA nephropathy in children.
        Contrib Nephrol. 1993; 104: 14-23
        • Julian B.A
        • Waldo F.B
        • Rifai A
        • Mestecky J
        IgA nephropathy, the most common glomerulonephritis worldwide. A neglected disease in the United States?.
        Am J Med. 1988; 84: 129-132
        • Madaio M.P
        Nephrology forum.
        Kidney Int. 1990; 38: 529-543
        • Cockroft D.W
        • Gault M.H
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        • Lai F.M
        • Szeto C.C
        • Choi P.C
        • et al.
        Characterization of early IgA nephropathy.
        Am J Kidney Dis. 2000; 36: 703-708
        • To K.F
        • Choi P.C.L
        • Szeto C.C
        • et al.
        Outcome of IgA nephropathy in adults graded by chronic histological lesions.
        Am J Kidney Dis. 2000; 35: 392-400
        • Li P.K
        • Lai K.N
        IgA nephropathy in Hong Kong.
        J Hong Kong Med Assoc. 1989; 41: 93-95
        • Li P.K
        • Poon A
        • Lai K.N
        Molecular genetics of MHC class II alleles in Chinese patients with IgA nephropathy.
        Kidney Int. 1994; 46: 185-190
        • McGregor D.O
        • Lynn K.L
        • Bailey R.R
        • et al.
        Clinical audit of the use of renal biopsy in the management of isolated microscopic hematuria.
        Clin Nephrol. 1998; 49: 345-348
        • Ruggenenti P
        • Perna A
        • Gherardi G
        • et al.
        Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril.
        Lancet. 1998; 352: 1252-1256
        • Ruggenenti P
        • Perna A
        • Gherardi G
        • et al.
        Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria.
        Lancet. 1999; 354: 359-364