Clinical and histopathological spectrum of IgA nephropathy in Kuwait

Podocytes are likely the therapeutic target of IgA nephropathy with isolated hematuria: Evidence from repeat renal biopsy

Background: The present study aimed to prove the progression of immunoglobulin A nephropathy (IgAN) patients with isolated hematuria based on repeat renal biopsy data for the first time. Methods: 29 IgAN patients with isolated hematuria who received repeat renal biopsies were analyzed retrospectively, while 29 non-isolated hematuria IgAN patients with similar age and background were randomly selected as the control group. Clinical parameters were collected at the time of biopsy. The treatment strategies (conservative treatment with RASS blocker or immunosuppressive treatment) were choosen according to the pathological results at the first renal biopsy. The activity and chronicity indexes of renal lesions were evaluated. Markers of cell inflammation and proliferation were tseted by immunochemistry. The ultrastructure of podocytes was observed by transmission electron microscopy (TEM). Podocyte and oxidative stress marker (NPHS2 and 4-HNE) were detected by immunofluorescence. Results: The IgAN patients with isolated hematuria had better clinical indicators than those with no-isolated hematuria, such as better renal function, higher albumin and lower uric acid. The interval between two biopsies in IgAN patients with isolated hematuria was 630 (interquartile range, 409.5-1,171) days. The hematuria of the patients decreased significantly from 30 (IQR, 4.00-35.00) RBC/ul in the first biopsy to 11 (IQR, 2.50-30.00) RBC/ul in the repeated biopsy (p < 0.05). The level of triglyceride decreased significantly (p < 0.05). The other clinical indicators were not statistically significant (p > 0.05). Deposits of IgA and C3 in the glomerulus were persistent. The activity index decreased, especially cellular crescent formation, while the chronicity index increased. The ultrastructure of podocytes was improved after treatment. The oxidative stress products of podocytes reduced after treatment. Conclusion: Although the clinical indicators of the IgAN patients with isolated hematuria were in the normal range, various acute and chronic pathological changes have occurred, and irreversible chronic changes have been progressing. Cell inflammation and proliferation persisted. Oxidative stress of podocytes was likely to be the therapeutic target. This study provided a strong basis for the progress of IgAN with isolated hematuria through pathological changes before and after treatment. This study will help clinicians recognize the harm of hematuria, change the traditional treatment concept, and help such patients get early treatment.

Immunoglobulin A (IgA) Nephropathy: A Clinicopathologic Study in a Tertiary Care Center in Saudi Arabia

Background: Immunoglobulin A nephropathy (IgAN) is the most common primary aetiology of glomerulonephritis worldwide, and it is the most important type in terms of morbidity and mortality. IgAN involves the deposition of immune bodies in the mesangial cells of the kidney, which causes renal glomerular damage, haematuria, proteinuria, and various other symptoms. Previous studies have mainly focused on the East Asian population, with few studies conducted in Saudi Arabia, particularly in the western region. The diagnosis requires a biopsy, which should be examined by an expert and classified according to the Oxford classification system.

Objectives: Analyze the clinical, pathological, and laboratory features of male and female patients diagnosed with IgAN at King Abdulaziz University Hospital (KAUH).

Methods and materials: This was a retrospective record review conducted at KAUH in Jeddah, Saudi Arabia between May-June 2021. The study included 18 patients diagnosed with IgAN by biopsy, and their clinical, laboratory and pathological data were evaluated and classified according to the Oxford classification system.

Results: Demographic data revealed a male predominance of 66.7%. The most common pathological finding was mesangial proliferation, and the most common presentation was haematuria. For treatment options, corticosteroids were the most prescribed drugs. A significant relationship was found between IgAN with increased serum creatinine and male sex (P = 0.017). Additionally, a significant relationship was observed between decreased estimated glomerular filtration rate (eGFR) in IgAN and the male sex (P = 0.006).

Conclusions: We found a difference in terms of pathological, clinical and laboratory presentations of IgAN between males and females. Men generally had worse kidney function at presentation and advanced Oxford classification in their kidney biopsies compared to women.

Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

Background: The relationship between hematuria, a typical presentation of immunoglobulin A nephropathy (IgAN), and long-term adverse prognosis of these patients is still controversial. This meta-analysis aims to clarify the effect of hematuria on renal outcomes in IgAN.

Methods: Observational cohort studies reporting associations between various forms of hematuria and renal outcomes among IgAN patients were identified from the PubMed and Embase databases. The pooled adjusted risk ratios (RRs) were computed with random effects models.

Results: Thirteen studies encompassing 5660 patients with IgAN were included. Patients with initial hematuria did not have a significantly increased risk of developing end-stage renal disease (ESRD) compared with those without hematuria (RR, 1.32; 95% CI, 0.87–2.00; p = .19). However, initial microscopic hematuria was associated with an 87% increase in the risk of ESRD (RR, 1.87; 95% CI, 1.40–2.50; p < .001), while macroscopic hematuria was associated with a 32% decrease in the risk of ESRD (RR, 0.68; 95% CI, 0.58–0.79; p < .001). Additionally, persistent hematuria might be an independent risk factor for ESRD or a 50% decline in eGFR.

Conclusions: Among IgAN patients, hematuria, including initial microscopic hematuria and even persistent hematuria, was possibly associated with renal progression and ESRD. However, independent of other classical predictors, initial macroscopic hematuria might be a protective factor for IgAN.