doiSerbia

Immunoglobulin A nephropathy and its prognostic factors

Petrović Lada (Klinički centar, Novi Sad - Institut za interne bolesti, Klinika za nefrologiju i kliničku imunologiju)
Čurić Slobodan (Klinički centar, Novi Sad - Institut za interne bolesti, Klinika za nefrologiju i kliničku imunologiju)
Mitić Igor (Klinički centar, Novi Sad - Institut za interne bolesti, Klinika za nefrologiju i kliničku imunologiju)
Božić Dušan (Klinički centar, Novi Sad - Institut za interne bolesti, Klinika za nefrologiju i kliničku imunologiju)
Vodopivec Slavenka (Klinički centar, Novi Sad - Institut za interne bolesti, Klinika za nefrologiju i kliničku imunologiju)
Sakač Vladimir (Klinički centar, Novi Sad - Institut za interne bolesti, Klinika za nefrologiju i kliničku imunologiju)
Đurđević-Mirković Tatjana (Klinički centar, Novi Sad - Institut za interne bolesti, Klinika za nefrologiju i kliničku imunologiju)
Ilić Tatjana (Klinički centar, Novi Sad - Institut za interne bolesti, Klinika za nefrologiju i kliničku imunologiju)

Introduction Immunoglobulin A nephropathy (IgAN) is a clinicopathological entity characterized by diffuse glomerular mesangial deposition of IgA as the predominant immunoglobulin. Renal biopsy reveals a spectrum of changes in glomerula, tubulointerstitium and blood vessels. 20-50% of all patients develop end-stage renal failure 20 years after onset of disease. The aim of this study was to investigate the incidence of IgAN and to analyze clinicopathological changes and prognosis of IgAN. Material and methods The study included 60 patients with biopsy-proved IgAN without some other systemic diseases or Henoch-Schonlen purpura. We analyzed clinical features of the disease, laboratory findings, findings of immunofluorescence and light microscopy and prognosis of IgAN. The study is partly retrospective and partly prospective. Results and discussion Incidence of the disease in the period 1981-1997 was 9.78%. At the moment of renal biopsy 63.16% of patients had normal renal function, 31.58% had stage I and 5.25% had stage II chronic renal failure. At the end of study 21.05% of investigated patients were included into the worse stage of renal failure in regard to the initial stage. Progression of renal damage correlated with special tubulointerstitial damage and heavy proteinuria. Conclusions In this study we found severe histopathological changes in the group with already impaired renal function and these changes correlated with laboratory findings, clinical features and prognosis. Normal renal function at the moment of renal biopsy pointed to risk for further damage. Changes in the tubulointerstitium and mesangium, heavy proteinuria and hypertension affect the disease prognosis. Evolution to the higher stage of renal failure was 1.24% per year and this requires long-term follow-up of patients with IgAN.

Keywords: glomerulonephritis, IgA, prognosis, kidney failure, chronic, proteinuria