title: Long-term outcomes of IgA nephropathy presenting with minimal or no proteinuria.
abstract: The long-term outcome of patients with IgA nephropathy who present with normal renal function, microscopic hematuria, and minimal or no proteinuria is not well described. Here, we studied 141 Caucasian patients with biopsy-proven IgA nephropathy who had minor abnormalities at presentation and a median follow-up of 108 months. None of the patients received corticosteroids or immunosuppressants. We reviewed renal biopsies using the Oxford classification criteria. In this sample, 46 (32%) patients had mesangial proliferation, whereas endocapillary proliferation, focal glomerulosclerosis, and tubulointerstitial abnormalities were uncommon. Serum creatinine increases >50% and >100% were observed in five (3.5%) patients and one (0.7%) patient, respectively; no patients developed ESRD. After 10, 15, and 20 years, 96.7%, 91.9%, and 91.9% of patients maintained serum creatinine values less than a 50% increase, respectively. Using Cox proportional hazards regression, the presence of segmental glomerulosclerosis was the only factor that significantly associated with a >50% increase in serum creatinine. Clinical remission occurred in 53 (37.5%) patients after a median of 48 months. Proteinuria>0.5 and >1.0 g/24 h developed in 21 (14.9%) and 6 (4.2%) patients, respectively. Median proteinuria at the end of follow-up was 0.1 g/24 h, with 41 (29.1%) patients having no proteinuria. At presentation, 23 (16.3%) patients were hypertensive compared with 30 (21.3%) patients at the end of follow-up; 59 (41.8%) patients were treated with renin-angiotensin blockers because of hypertension or increasing proteinuria. In summary, the long-term prognosis for Caucasian patients with IgA nephropathy who present with minor urinary abnormalities and normal renal function is excellent.
authors.affiliation: Department of Nephrology, Hospital 12 de Octubre, Avenida de Córdoba s/n, Madrid, Spain. eduardogm90@hotmail.com
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gutiérrez
authors.forename: Isabel
authors.initials: I
authors.lastname: Zamora
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Ballarín
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Arce
authors.forename: Sara
authors.initials: S
authors.lastname: Jiménez
authors.forename: Carlos
authors.initials: C
authors.lastname: Quereda
authors.forename: Teresa
authors.initials: T
authors.lastname: Olea
authors.forename: Jorge
authors.initials: J
authors.lastname: Martínez-Ara
authors.forename: Alfons
authors.initials: A
authors.lastname: Segarra
authors.forename: Carmen
authors.initials: C
authors.lastname: Bernis
authors.forename: Asunción
authors.initials: A
authors.lastname: García
authors.forename: Marian
authors.initials: M
authors.lastname: Goicoechea
authors.forename: Soledad
authors.initials: S
authors.lastname: García de Vinuesa
authors.forename: Jorge
authors.initials: J
authors.lastname: Rojas-Rivera
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology; D055815:Young Adult
chemical_list: D003404:Creatinine