Factors that determine an incomplete recovery of renal function in macrohematuria-induced acute renal failure of IgA nephropathy.
Acute renal failure that is associated with macroscopic hematuria (ARF-MH) is a widely known complication of IgA nephropathy (IgAN). Although spontaneous recovery of renal function after cessation of MH has been described, no long-term outcome studies have been performed. The outcome of patients who had biopsy-proven IgAN and presented an ARF-MH episode in the period 1975 through 2005 was studied. Thirty-six episodes of ARF-MH that occurred in 32 patients were identified. A complete recovery of baseline renal function after cessation of MH was observed in 27 (group 1); in the remaining nine episodes (25%; group 2), estimated GFR (eGFR) did not reach the baseline value. Final eGFR was 89 +/- 28 ml/min per 1.73 m(2) in group 1 patients and 38 +/- 12 ml/min per 1.73 m(2) in group 2 patients (P = 0.0005). The duration of MH was significantly longer in group 2 patients: 33.7 +/- 25.3 versus 15.4 +/- 18.4 d (P = 0008). A high proportion of tubules that were filled by red blood cell casts and had signs of acute tubular necrosis were the most striking histologic abnormalities. In conclusion, a significant proportion (25%) of ARF-MH in IgAN did not recover the baseline renal function after the disappearance of MH. Duration of MH longer than 10 d, age >50 yr, decreased baseline eGFR, absence of previous episodes of MH, and the severity of tubular necrosis were significant risk factors for an incomplete recovery of renal function.
Gutiérrez
Eduardo
E
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
González
Esther
E
Hernández
Eduardo
E
Morales
Enrique
E
Martínez
M Angel
MA
Usera
Gabriel
G
Praga
Manuel
M
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D006417:Hematuria / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013256:Steroids / Q000627:therapeutic use
D013256:Steroids; D003404:Creatinine