title: Clinicopathologic features of IgA-dominant infection-associated glomerulonephritis: a pooled analysis of 78 cases.
abstract: BACKGROUND
  IgA-dominant infection-associated glomerulonephritis (IgA-dominant IAGN) is a unique form of glomerulonephritis. There are numerous case reports in the literature. However, the risk factors, treatment approach, and outcomes of the disease are not clearly characterized.
  
  
  METHODS
  We completed a pooled analysis based on published literature. Clinical features, laboratory findings, and histopathological changes were analyzed. A logistic regression model was employed to identify the determinants of disease outcome, for example, end-stage renal disease (ESRD) or death.
  
  
  RESULTS
  Seventy-eight patients with IgA-dominant IAGN from 28 reports were analyzed. All of these patients showed granular IgA deposits predominantly along the glomerular peripheral capillary walls using immunofluorescence and majority showed subepithelial 'hump-shaped' electron-dense deposits using electron microscopy. The majority of patients had hematuria (76/78), proteinuria (75/78), acute kidney injury (AKI) (66/78) and hypocomplementemia (43/75) without a previous history of renal disease. All of the patients had clinical infections at the time of presentation. Skin infections (19/78) and visceral abscesses (15/78) were frequently encountered, and staphylococcus was the most common pathogen. After treatment with antibiotics and/or supportive therapy, the renal function of 42 patients (54.5%) improved, 9 patients (11.7%) had persistent renal dysfunction, 15 patients (19.5%) progressed to ESRD, and 11 patients (14.3%) died. A multivariate regression analysis revealed that age (odds ratio [OR], 30.71; 95% confidence interval [CI], 2.53-373.07; p = 0.007) and diabetes mellitus (DM) (OR, 16.65; 95% CI, 1.18-235.84; p = 0.038) were independent risk factors for ESRD or death.
  
  
  CONCLUSIONS
  IgA-dominant IAGN has unique clinicopathological manifestations and treatment responses. Age and DM are independent risk factors associated with an unfavorable prognosis for IgA-dominant IAGN.
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, PR China.
authors.forename: Ru
authors.initials: R
authors.lastname: Bu
authors.forename: Qian
authors.initials: Q
authors.lastname: Li
authors.forename: Zhi-yu
authors.initials: ZY
authors.lastname: Duan
authors.forename: Jie
authors.initials: J
authors.lastname: Wu
authors.forename: Pu
authors.initials: P
authors.lastname: Chen
authors.forename: Xiang-mei
authors.initials: XM
authors.lastname: Chen
authors.forename: Guang-yan
authors.initials: GY
authors.lastname: Cai
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D002097:C-Reactive Protein / Q000378:metabolism; D003165:Complement System Proteins / Q000378:metabolism; D048909:Diabetes Complications / Q000150:complications; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000097:blood / Q000150:complications / Q000382:microbiology* / Q000401:mortality / Q000473:pathology*; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D011507:Proteinuria / Q000209:etiology; D014777:Virus Diseases
chemical_list: D000900:Anti-Bacterial Agents; D003165:Complement System Proteins; D002097:C-Reactive Protein