title: IgA nephropathy clinicopathologic study following the Oxford classification: Progression peculiarities and gender-related differences.
abstract: OBJECTIVE
  Immunoglobulin A nephropathy (IgAN) is the most frequent glomerular disease worldwide and one of the main causes of chronic kidney disease. We aimed to investigate clinicopathological correlations in IgAN patients by gender.
  
  
  METHODS
  The study was based on a retrospective analysis of renal biopsy data and clinical manifestations of the disease. Consecutive 73 biopsy-proven IgAN cases of male (62%) and female (38%) patients were investigated. Renal biopsies were reviewed using the new Oxford classification assessing the MEST (mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis/adhesion, tubular atrophy/interstitial fibrosis) score. The most powerful IgAN prognostic risk factors, morphological (segmental glomerulosclerosis and tubular atrophy/interstitial fibrosis) as well as clinical (proteinuria and hypertension) were taken into account in the correlation analysis. The mean rate of renal function decline was expressed as a slope of eGFR during the follow-up (FU) dividing delta GFR with the FU years.
  
  
  RESULTS
  The mean age of the patients was 33.7 years (range, 16-76). Follow-up data were available for 64 patients with the mean follow-up of 4.1 years. The mean proteinuria at biopsy was 0.79g/24h. The mean arterial pressure (MAP) was 94.5±16.7mmHg and 7% of the patients were hypertensive. The initial mean estimated glomerular filtration rate (eGFR) was 94.9±30.7mL/min, at the end of the follow-up it was 86.2±27.1mL/min. The mean rate of renal function decline was -3.4±11.9mL/min/1.73m2per year in males (P<0.05) and -0.7±5.3mL/min/1.73m2per year in females. The Spearman correlation analysis confirmed a higher MEST score in the whole cohort and in males correlated with disease progression. In patients with proteinuria below 1.0g/24h, disease progression was faster in males.
  
  
  CONCLUSIONS
  According to the correlation analysis of the main prognostic risk factors, affecting the progression of IgAN, we can conclude that IgA nephropathy in males progresses more rapidly compared to females.
authors.affiliation: Institute of Pathological Anatomy and Forensic Medicine, Tartu University, Tartu, Estonia.
authors.forename: Živile
authors.initials: Ž
authors.lastname: Riispere
authors.affiliation: Vilnius University and National Centre of Pathology, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
authors.forename: Arvydas
authors.initials: A
authors.lastname: Laurinavičius
authors.affiliation: Institute of Pathological Anatomy and Forensic Medicine, Tartu University, Tartu, Estonia.
authors.forename: Anne
authors.initials: A
authors.lastname: Kuudeberg
authors.affiliation: Department of Internal Medicine, Tartu University and Tartu University Hospital, Tartu, Estonia.
authors.forename: Elviira
authors.initials: E
authors.lastname: Seppet
authors.affiliation: West-Tallinn Central Hospital, Tallinn, Estonia.
authors.forename: Kristin
authors.initials: K
authors.lastname: Sepp
authors.affiliation: West-Tallinn Central Hospital, Tallinn, Estonia.
authors.forename: Madis
authors.initials: M
authors.lastname: Ilmoja
authors.affiliation: North Estonia Medical Centre, Tallinn, Estonia.
authors.forename: Merike
authors.initials: M
authors.lastname: Luman
authors.affiliation: Department of Internal Medicine, Tartu University and Tartu University Hospital, Tartu, Estonia.
authors.forename: Külli
authors.initials: K
authors.lastname: Kõlvald
authors.affiliation: North Estonia Medical Centre, Tallinn, Estonia.
authors.forename: Asta
authors.initials: A
authors.lastname: Auerbach
authors.affiliation: Department of Internal Medicine, Tartu University and Tartu University Hospital, Tartu, Estonia. Electronic address: Mai.Rosenberg@kliinikum.ee.
authors.forename: Mai
authors.initials: M
authors.lastname: Ots-Rosenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005922:Glomerulonephritis, IGA / Q000145:classification* / Q000473:pathology*; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013223:Statistics as Topic
keywords: Gender-related differences; Glomerular filtration rate; IgA nephropathy; Oxford classification of IgA nephropathy; Renal biopsy