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Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria

Background: The relationship between hematuria and histological lesions, the effect of hematuria on response to steroid therapy, and the outcome in patients with immunoglobulin A nephropathy (IgAN) remain undetermined. Objectives: The aim of this study was to clarify the effect of hematuria on histo...

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Autores principales: Iwasaki, Chihiro, Moriyama, Takahito, Tanaka, Kayu, Takei, Takashi, Nitta, Kosaku
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Society of Diabetic Nephropathy Prevention 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844912/
https://www.ncbi.nlm.nih.gov/pubmed/27152293
http://dx.doi.org/10.15171/jnp.2016.12
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author Iwasaki, Chihiro
Moriyama, Takahito
Tanaka, Kayu
Takei, Takashi
Nitta, Kosaku
author_facet Iwasaki, Chihiro
Moriyama, Takahito
Tanaka, Kayu
Takei, Takashi
Nitta, Kosaku
author_sort Iwasaki, Chihiro
collection PubMed
description Background: The relationship between hematuria and histological lesions, the effect of hematuria on response to steroid therapy, and the outcome in patients with immunoglobulin A nephropathy (IgAN) remain undetermined. Objectives: The aim of this study was to clarify the effect of hematuria on histological findings, response to steroid treatment, and the outcome in IgA nephropathy. Patients and Methods: Seventy-five patients with IgAN and proteinuria > 1 g/day and treated with prednisolone were divided into two groups: those with low (≤20/high-power field [HPF]) urinary red blood cell (U-RBC) counts (L-RBC group, n=55) and those with high (>20/HPF) U-RBC counts (H-RBC group, n=20). Their clinical and histological characteristics, the relationship between hematuria and histological lesions, renal outcomes, and risk factors for progression were compared. Results: Except for U-RBC counts, the clinical and histological findings according to the Oxford classification of the two groups were similar. U-RBC counts were not correlated with active histological lesions. Median proteinuria in both groups decreased soon after starting steroid therapy. Median U-RBC also decreased after starting steroids, and it became similar between both groups at 2 years after treatment. The 20-year renal survival rate was also similar between the H-RBC and the L-RBC group (45.2% versus 58.0%, P=0.5577). Multivariate Cox regression analysis showed that the lower estimated glomerular filtration rate (eGFR) was an independent risk factor for progression. Conclusions: A higher degree of hematuria at renal biopsy in patients with IgAN was not associated with active pathological lesions, such as cellular and fibro-cellular crescents, resistance to steroid treatment and poor outcome.
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spelling pubmed-48449122016-05-05 Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria Iwasaki, Chihiro Moriyama, Takahito Tanaka, Kayu Takei, Takashi Nitta, Kosaku J Nephropathol Original Article Background: The relationship between hematuria and histological lesions, the effect of hematuria on response to steroid therapy, and the outcome in patients with immunoglobulin A nephropathy (IgAN) remain undetermined. Objectives: The aim of this study was to clarify the effect of hematuria on histological findings, response to steroid treatment, and the outcome in IgA nephropathy. Patients and Methods: Seventy-five patients with IgAN and proteinuria > 1 g/day and treated with prednisolone were divided into two groups: those with low (≤20/high-power field [HPF]) urinary red blood cell (U-RBC) counts (L-RBC group, n=55) and those with high (>20/HPF) U-RBC counts (H-RBC group, n=20). Their clinical and histological characteristics, the relationship between hematuria and histological lesions, renal outcomes, and risk factors for progression were compared. Results: Except for U-RBC counts, the clinical and histological findings according to the Oxford classification of the two groups were similar. U-RBC counts were not correlated with active histological lesions. Median proteinuria in both groups decreased soon after starting steroid therapy. Median U-RBC also decreased after starting steroids, and it became similar between both groups at 2 years after treatment. The 20-year renal survival rate was also similar between the H-RBC and the L-RBC group (45.2% versus 58.0%, P=0.5577). Multivariate Cox regression analysis showed that the lower estimated glomerular filtration rate (eGFR) was an independent risk factor for progression. Conclusions: A higher degree of hematuria at renal biopsy in patients with IgAN was not associated with active pathological lesions, such as cellular and fibro-cellular crescents, resistance to steroid treatment and poor outcome. Society of Diabetic Nephropathy Prevention 2016-04 2016-02-25 /pmc/articles/PMC4844912/ /pubmed/27152293 http://dx.doi.org/10.15171/jnp.2016.12 Text en © 2016 The Author(s) Published by Society of Diabetic Nephropathy Prevention. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Iwasaki, Chihiro
Moriyama, Takahito
Tanaka, Kayu
Takei, Takashi
Nitta, Kosaku
Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria
title Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria
title_full Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria
title_fullStr Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria
title_full_unstemmed Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria
title_short Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria
title_sort effect of hematuria on the outcome of immunoglobulin a nephropathy with proteinuria
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844912/
https://www.ncbi.nlm.nih.gov/pubmed/27152293
http://dx.doi.org/10.15171/jnp.2016.12
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