title: Maximal glomerular diameter as a 10-year prognostic indicator for IgA nephropathy.
abstract: BACKGROUND
  Although there have been many reports on clinicopathological studies of immunoglobulin A nephropathy (IgAN), reliable outcome predictors are still lacking. We therefore assessed maximal glomerular diameter (Max GD), an indicator of glomerular size, as a predictor of the long-term evolution of renal histopathology.
  
  
  METHODS
  Forty-three adult patients, diagnosed with IgAN, who had estimated glomerular filtration rate (eGFR) ≥50 mL/min/1.73 m(2), were enrolled in this study. Prognostic variables for renal survival were examined by using the multivariate Cox proportional hazards method. The optimal cut-off value of Max GD was 242.3 μm (AUC = 0.78, sensitivity = 62.5%, specificity = 81.5%) by using receiver operating characteristics analysis. In order to assess the characteristics of glomerular hypertrophy, we divided the cases into two groups according to the Max GD value (Group A, ≥242 μm; Group B, <242 μm). Renal survival was also assessed by Kaplan-Meier curves with the log-rank test.
  
  
  RESULTS
  The Max GD was significantly correlated with age, body mass index and serum triglyceride levels at the time of renal biopsy. During the 10-year follow-up period, the Max GD was significantly correlated with eGFR decline per year, and proteinuria, but not with hematuria. A multiple regression analysis by the Cox method adjusted for age, sex and eGFR showed that the Max GD values were significantly associated with a 1.5-fold increase in serum creatinine (Cr) values (hazard ratio = 1.04, P = 0.03). Renal function in 66.7% of the patients whose Max GD was ≥242 μm had at least a 1.5-fold increase in their serum Cr value at the 10-year follow-up examination (log-rank, P = 0.003).
  
  
  CONCLUSIONS
  The results of this study suggest that Max GD is a simple quantitative prognostic indicator of the disease progression in IgAN patients.
authors.affiliation: Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kataoka
authors.forename: Mamiko
authors.initials: M
authors.lastname: Ohara
authors.forename: Kazuho
authors.initials: K
authors.lastname: Honda
authors.forename: Takahiro
authors.initials: T
authors.lastname: Mochizuki
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005922:Glomerulonephritis, IGA / Q000473:pathology*; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D013997:Time Factors; D055815:Young Adult