Naslov
CLINICAL AND PATOHISTOLOGICAL DIFFERENCES IN PATIENTS WITH IGA NEPHROPATHY WHERE REBIOPSY WAS INDICATED: SINGLE CENTER STUDY
(SP186CLINICAL AND PATOHISTOLOGICAL DIFFERENCES IN PATIENTS WITH IGA NEPHROPATHY WHERE REBIOPSY WAS INDICATED: SINGLE CENTER STUDY)

Autori
Torić, Luka ; Horvatić, Ivica ; Crnogorac, Matija ; Rajic Toric, Ivana ; Nikola, Zagorec ; Kasumović, Dino ; Brechelmacher, Ana ; Galešić Ljubanović, Danica ; Galešić, Krešimir

Izvornik
Nephrology Dialysis Transplantation (0931-0509) 34 (2019), Supplement_1; SP186, 1

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, ostalo

Ključne riječi
iga glomerulonephritis

Sažetak
INTRODUCTION: In our registry, IgA nephropathy is the most common glomerulonephritis. Clinical and histological manifestations of IgA nephropathy are very heterogeneous as well as patient’s outcomes. In our center, we perform a kidney biopsy in patients with microscopic glomerular hematuria and/or significant proteinuria (above 500mg/day). The indications for kidney re-biopsy in IgA nephropathy are still debated, and range from protocoled biopsies (follow-up after treatment) to indication re-biopsies (when there is worsening or atypical clinical course). We aimed to investigate the differences in clinical and pathological features of the IgA nephropathy patients where re-biopsy was and wasn’t indicated. 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 there were 18 (9.2%) in the rebiopsy group. Median age at biopsy of those patients was 39 years (interquartile range IQR 25-43), which was significantly lower than the non-rebiopsy group (p=0.005). In rebiopsy group patients presented significantly more often with asymptomatic proteinuria and microscopic hematuria (50% of the patients) and with nephrotic syndrome (44.4%) at time of presentation compared to non-rebiopsy group (p=0.014). Between these two groups, there were no significant differences in serum creatinine, eGFR, microscopic hematuria, serum level of C3, C4, IgA, hemoglobin and blood pressure. Daily proteinuria was significantly higher (median 2.9 gram, IQR 1.2-7.4 ; p=0.003) and serum albumin was lower (median 36 g/l, IQR 26-38 ; p<0.001) in rebiopsy group. There were no significant differences between these two groups in M, E, S and T component of Oxford classification, but patients where rebiopsy was performed had significantly more often C1 (44.4% of the patients) and C2 (11.1%) component than non-rebiopsy patients (p=0.026). CONCLUSIONS: In patient where rebiopsy was performed, presented significantly more often with asymptomatic proteinuria and microscopic hematuria and with nephrotic syndrome, had higher daily proteinuria, lower serum albumin and more frequently crescents in renal biopsy at the time of presentation compared with non- rebiopsy IgA nephropathy patients. The clinical implications of those findings need to be studied further in prospective trials.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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