Presentation, prognosis and outcome of IgA nephropathy in Indian adults.
BACKGROUND
IgA nephropathy (IgAN) is not well characterized in India. This retrospective study of 478 patients with IgAN was performed to clarify the presenting features, prognostic factors and the renal survival rates of the disease.


METHODS
Three hundred and forty-seven patients who had been followed on average for 27 months after diagnosis were divided into two groups based on renal function at diagnosis. In group 1 (229 patients), the creatinine clearance estimated by the Modification of Diet in Renal Disease formula was <85 mL/min and in group 2 (118 patients) it was >/=85 mL/min.


RESULTS
The predominant modes of presentation were nephrotic syndrome, hypertension and renal failure. Twenty-nine percent of patients had more than a 20% decline in renal function at the last follow up. Multivariate analyses with stepwise logistic regression identified hypertension (odds ratio (OR) 3.5), nephrotic range proteinuria (OR 3.4) and sclerosed glomeruli on biopsy (OR 4.1) to be independently associated with progression in group 1 and hypertension (OR 2.3) in group 2. Seventeen percent of patients progressed to end-stage renal disease (ESRD). Using multivariate analysis by the Cox model, four risk factors for developing ESRD were identified: hypertension (hazard ratio (HR) 3.1); nephrotic proteinuria (HR 1.9); interstitial fibrosis (HR 2.5); and sclerosed glomeruli (HR 1.8). The renal survival rates at 1, 5 and 10 years were 84, 55 and 33%, respectively, with a median renal survival of 61 months from the time of biopsy.


CONCLUSIONS
The relatively rapid rate of progression of IgAN in India is suggestive towards a 'malignant' nature of the disease in this country.
Chacko
Bobby
B
Department of Nephrology, Christian medical college, Vellore, India.
John
George T
GT
Neelakantan
Nithya
N
Korula
Anila
A
Balakrishnan
Narasimhan
N
Kirubakaran
Meshach G
MG
Jacob
Chakko K
CK
D000293:Adolescent; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000401:mortality*; D006801:Humans; D007194:India / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D003404:Creatinine