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J Nephropathol. 2016;5(2): 72-78.
doi: 10.15171/jnp.2016.12
PMID: 27152293
PMCID: PMC4844912
Scopus ID: 84963542058
  Abstract View: 3141
  PDF Download: 1292

Original Article

Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria

Chihiro Iwasaki 1, Takahito Moriyama 1*, Kayu Tanaka 1, Takashi Takei 1, Kosaku Nitta 1

1 Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan
*Corresponding Author: *Corresponding author: Takahito Moriyama, MD, PhD, Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Kawada-cho 8-1, Shinjyuku-ku, Tokyo, Japan, , Email: takamori@kc.twmu.ac.jp

Abstract

Background:The relationship between hematuria and histological lesions, the effect of hematuria on response to steroid therapy, and the outcome in patients with immunoglobulin A nephropathy (IgAN) remain undetermined.

Objectives: The aim of this study was to clarify the effect of hematuria on histological findings, response to steroid treatment, and the outcome in IgA nephropathy.

Patients and Methods: Seventy-five patients with IgAN and proteinuria > 1 g/day and treated with prednisolone were divided into two groups: those with low (≤20/high-power field [HPF]) urinary red blood cell (U-RBC) counts (L-RBC group, n=55) and those with high (>20/HPF) U-RBC counts (H-RBC group, n=20). Their clinical and histological characteristics, the relationship between hematuria and histological lesions, renal outcomes, and risk factors for progression were compared.

Results: Except for U-RBC counts, the clinical and histological findings according to the Oxford classification of the two groups were similar. U-RBC counts were not correlated with active histological lesions. Median proteinuria in both groups decreased soon after starting steroid therapy. Median U-RBC also decreased after starting steroids, and it became similar between both groups at 2 years after treatment. The 20-year renal survival rate was also similar between the H-RBC and the L-RBC group (45.2% versus 58.0%, P=0.5577). Multivariate Cox regression analysis showed that the lower estimated glomerular filtration rate (eGFR) was an independent risk factor for progression.

Conclusions: A higher degree of hematuria at renal biopsy in patients with IgAN was not associated with active pathological lesions, such as cellular and fibro-cellular crescents, resistance to steroid treatment and poor outcome.


Implication for health policy/practice/research/medical education:

In a study on 75 patients with IgAN and proteinuria >1 g/day, we found, the degree of hematuria did not have any relationship with histological activity. Additionally, the effect of steroid treatment was similar and long-term prognosis after steroid treatment was also similar, regardless of the degree of hematuria.

Please cite this paper as:Jwasaki C, Moriyama T, Tanaka K, Takei T, Nitta K. Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria. J Nephropathol. 2016;5(2):72-78. DOI: 10.15171/jnp.2016.12

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ePublished: 25 Feb 2016
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