Post Date December, 02 2023
IgA nephropathy is the most common type of chronic nephritis, with 80% of patients occurring in young adults. The diagnosis must rely on renal biopsy.
"Different patients with IgA nephropathy have significant differences in clinical indicators, response to treatment, and pathological findings at the time of discovery. Therefore, there are also significant differences in disease outcomes.". Mild cases only manifest as simple hematuria, with a good long-term prognosis; Fierce cases can manifest as rapidly progressive nephritis, rapidly progressing to end-stage renal failure.
Today, let's learn about the prognosis of IgA nephropathy.
What clinical indicators indicate the risk of renal function progression?
1. Continuous (more than half a year) 24-hour urinary protein quantification greater than 1g
Many studies have shown that patients with 24-hour urinary protein lower than 1g have a much slower rate of disease progression than patients with 24-hour urinary protein greater than 3g. The comparison between the prognosis of 0.5 to 1 g of urinary protein and that of less than 0.5 g is still controversial. In China, it is generally required that the quantitative determination of urinary protein be less than 0.5 g to be safer.
2. Serum creatinine at diagnosis
Currently, a large study believes that the cumulative probability of entering end-stage renal failure is greater than 26% after a 7-year follow-up with a serum creatinine level of>111 mmol/L at the onset of the disease; At the onset of the disease, the probability of reaching the end stage within 7 years is lower than 3% when the serum creatinine is less than 111 mmol/L.
The increased creatinine at the onset of the disease indicates a poor prognosis.
3. High blood pressure or 30mmHg increase in blood pressure during onset
Studies suggest that blood pressure higher than 140/90 mmHg or 30 mmHg increase in blood pressure at the onset of IgA nephropathy are adverse prognostic factors. In a follow-up study that was observed for 10-20 years, the cumulative probability of dialysis or death in patients with elevated blood pressure was 5-7 times higher than in those with normal blood pressure.
This is because high blood pressure at the time of onset generally indicates a more severe pathology in the patient.
What about pathology?
Currently, the most widely used pathological classification in clinical practice is Oxford classification. You can learn from your own puncture pathology.
M represents mesangial hyperplasia; S represents segmental hardening; E represents endothelial cell proliferation; T represents renal tubular atrophy and interstitial fibrosis. Except for T, which has 0, 1, and 2 points, M, E, and S all have 0 and 1 points.
The strongest predictor of prognosis in Oxford's classification is T, which is renal tubulointerstitial lesions. The higher the score, the poorer the prognosis. E is considered to be the weakest predictor of prognosis. Whether S and M can be used as independent prognostic factors is still controversial, so it is necessary to combine clinical indicators.
More severe pathology suggests poorer clinical indicators and treatment responses.
"However, the judgment of prognosis and treatment for crescent lesions has not been included, and experts in Oxford typing say the main reason is the low proportion of pathological crescents selected.". A study from the Department of Nephrology at Peking University's First Hospital included more patients with crescent lesions, and found no significant prognostic implications for crescent lesions. A Japanese study reached the same conclusion, but concluded that when the glomerular filtration rate is below 30, the crescent body is a positive predictor of prognosis.
Therefore, comprehensive clinical indicators and pathology can have a preliminary judgment on the prognosis.
Overall, IgA nephropathy has urinary protein levels consistently below 0.5g, normal blood pressure, normal creatinine, and a low risk of renal failure. Persistent urinary protein greater than 1 g, poor treatment response, elevated creatinine, and high blood pressure indicate a high risk of renal function progression.
In particular, there are relatively few patients with clinical punctures such as simple hematuria or hematuria accompanied by a small amount of urinary protein (less than 0.5g/day), because renal puncture is generally considered for patients with hematuria above 0.5g (there are some special cases), but this type of basic IgA nephropathy accounts for the vast majority. For such patients, it is recommended to check urine routine and renal function within 6-12 months, and measure blood pressure at ordinary times. If regular reexaminations reveal increased urinary protein and high blood pressure progression, timely intervention should be provided. "Because the long-term prognosis is good, do not carry too much psychological burden. Do not do it yourself. If you have to find a prescription to cure it, money is a small matter, causing renal tubulointerstitial damage will be a big problem.".
