engleski

SP155CLINICAL AND PATHOHISTOLOGICAL FEATURES IN PATIENTS WITH CRESCENTIC IGA NEPHROPATHY: SINGLE CENTER STUDY

INTRODUCTION: IgA nephropathy is the most common primary glomerulonephritis in the world. It can be manifested by all clinical syndromes, most often with asymptomatic proteinuria and microscopic hematuria (in 30-40% of the patients). Pathohistological features of the disease are also very diverse, ranging from mild mesangioproliferative glomerulonephritis to end stage renal disease (ESRD). In literature, 20% of the IgA nephropathy patients have crescents in renal biopsy, which together with MEST score, are considered important prognostic factors in renal outcome. We aimed to investigate differences in clinical and pathological features of IgA nephropathy patients with and without crescents in renal biopsy. METHODS: In this retrospective study all IgA nephropathy patients from 2008 until 2018 in our center were included. Patients were divided into two groups: the rebiopsy group and non- rebiopsy group. The indications for rebiopsy were reappearance of nephrotic proteinuria and/or worsening of proteinuria in patients who were in complete remission and/or worsening of renal function. We did not include patients into rebiopsy group where protocol biopsy or follow-up (after treatment) biopsy were performed. We analyzed epidemiological data (gender and age) and clinical data (clinical syndrome, serum creatinine, eGFR, daily proteinuria, microscopic hematuria, serum albumin, hemoglobin, IgA, C3, C4 and blood pressure). Also, the parameters of the Oxford classification: mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C) were compared between the two groups. RESULTS: There were 194 IgA nephropathy patients included in the study, from which 69 (35.6%) had crescentic form of the disease. Crescentic IgA nephropathy patients were significantly younger (median age 43 years ; interquartile range IQR 31-53) than patients without crescents (p=0.042). The patients with crescentic IgA nephropathy mostly presented with asymptomatic proteinuria and microscopic hematuria (42.0%), same as the other group, but had significantly more acute nephritic (15.9%) and rapidly progressive nephritic syndrome (8.7%) at the time of presentation (p<0.001). There were no significant differences in gender, serum creatinine, eGFR, microscopic hematuria, serum level of C3, C4, IgA, albumin, hemoglobin and blood pressure between groups. Daily proteinuria was higher in crescentic group (median 2.2 gram ; IQR 1.0-4.2 ; p<0.001). Compared to non-crescentic IgA nephropathy, patients in crescentic group had significantly more often M1 component (in 76.8% of the patients ; p = 0.012) and E1 component (in 73.9% ; p<0.001) in renal biopsy. There were no differences between these two groups in the distribution of S and T components of the Oxford classification. CONCLUSIONS: Patients with crescentic form of IgA nephropathy were younger, had higher daily proteinuria, more commonly presented with acute nephritic/rapidly progressive nephritic syndrome and had more often M1 and E1 compared to non-crescentic forms. The clinical implications of these findings need to be studied further in prospective trials.

iga glomerulonephritis

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