Insulin resistance and the progression of IgA glomerulonephritis (original) (raw)
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Nephrology Dialysis Transplantation, 2001
Background and methods. In order to examine the clinical outcome of IgA nephropathy (IgAN) superimposed on diabetic glomerulosclerosis in type 2 patients we studied 36 Chinese patients (26 men, 10 women), who were recruited for renal biopsy when they had proteinuria of more than 1 guday. Twentyseven had isolated diabetic glomerulosclerosis and nine had IgAN superimposed on diabetic glomerulosclerosis (combined). Renal function was assessed by serial serum creatinine, 24-h urine protein and creatinine measurements. Patient survival rate, incidence of end-stage renal disease (ESRD), blood pressure, and glycaemic control status were determined. Results. The age at the time of renal biopsy was younger for the combined group when compared with the diabetic glomerulosclerosis group (44"3.6 vs 58"2.1 years, Ps0.006). The duration of diabetes was, however, similar for the two groups (8.0"2.3 vs 6.7"1.2 years, PsNS). After a mean follow-up of 31.6"15.3 months, 15 patients (one in the combined group and 14 in the diabetic glomerulosclerosis group) developed ESRD. Nine patients (all in the diabetic glomerulosclerosis group) died during follow-up. With similar glycaemic and blood pressure control, the two groups had comparable rate of decline of creatinine clearance (CrCl) (À0.73"0.26 vs À0.73" 0.18 mluminu1.73 m 2 u month, PsNS), ®nal serum creatinine (363"134 vs 426"52 mmolul, PsNS) and proteinuria levels (4.3"0.9 vs 4.4"0.6 guday, PsNS), as well as CrCl (44.1"19.0 vs 33.4"6.9 mluminu 1.73 m 2 , PsNS). Conclusion. It is concluded that the superimposed IgAN does not signi®cantly alter the medium-term clinical outcome of patients with diabetic glomerulosclerosis.
Background. Proteinuria is the hallmark of glomerular disease and non-selective proteinuria is often associated with progression to renal failure. The predictive value of urine IgG excretion was studied comprehensively in patients with nephrotic syndrome. In the present follow-up study, we examine the predictive value of IgG-uria in patients with idiopathic glomerular diseases with a wide range of proteinuia. Methods. A total of 189 (113 males and 76 females) patients with idiopathic glomerulonephritis and serum creatinine of less than 150 μ mol/L diagnosed between 1993 and 2004 were followed up to their last visit in 2009. Measurement of urine excretion of albumin, IgG, and protein HC were performed in the early morning of spot urine samples collected at the time of the diagnostic renal biopsy. Patients were stratifi ed according to urine protein concentrations and the progression rate to end-stage renal disease (ESRD) calculated using Kaplan -Meier survival analysis. ESRD was defi ned as the start of renal replacement therapy. Results. During the study follow-up time of 1429 person-years; 26 (13.8%) patients reached ESRD. The overall mean kidney survival time of studied patients with serum creatinine less than 150 were 13.4 years. The incidence rate of ESRD was ∼ 18 per 1000 person-years. Stratifi ed analysis identifi ed urinary excretion of IgG, but not albuminuria, as predictor of ESRD. The progression rate to ESRD was 36 per 1000 person-years in patients with urine IgG concentration exceeding 5 mg/mmol urine creatinine, compared to a progression rate of 6/1000 person-years for patients with lower levels of urine IgG. Conclusion . The fi ndings of the study suggest that at early stages, the level of IgG-uria is useful to be used in risk stratifi cation of patients with proteinuric glomerular diseases.
Can we use serum and urine immunoglobulin levels as biomarkers in patients with glomerulonephritis?
Immunopathologia Persa
Introduction: Non-invasive biomarkers for assessing disease activity and progression are continuously being sought, but difficult to validate. For glomerulonephritis (GN), various molecules in both blood and urine are undergoing stringent research. Immunoglobulin (Ig) levels have also been sought as potential biomarkers with variable results. Objectives: We aimed at determining the utility of serum and urine Ig levels to ascertain severity of proteinuria and renal functions in GN patients. Materials and Methods: Blood and urine of 25 GN patients and 13 healthy controls were tested for Ig levels including IgG, IgM, IgA and IgE. The degree of proteinuria, renal functions and histopathological features were recorded from the case files of these patients. Results: The mean serum IgM and IgA levels were significantly high in GN patients compared to controls. However, two patients had high IgM and one had high IgA levels. Three patients had low IgG levels but did not correlate with urinary loss. Moreover IgGuria was not different in patients with or without severe disease. In patients with acute GN IgMuria was more prevalent. While in chronic GN, IgAuria was more common. Mean serum IgE levels were more in healthy controls and did not correlate with renal dysfunction. However, mean IgEuria was more pronounced in patients with renal dysfunction Conclusion: The utility of serum and urine Ig as biomarkers of disease activity and progression in GN patients is still debatable and require further studies. Abnormal levels of these proteins in blood of GN patients require further workup to rule out any concomitant pathology.
A Case Controlled Study on Clinical Attributes of Patients in Intercapillary Glomerulonephritis
Introduction: End stage renal failure eventually develops in 40% of patients with diabetes, the IDDM constitute the single most usual disease leading to inadequacy in adults. Patients with type 2 diabetes had higher HBA1c and FBS together that is distinctly reduced the reactiveness of insulin in contrast to healthy control subjects. On average, death takes place 7years after the start of persistent proteinuria but the scale is wide (2-32) years. Even though morphological bruises advance and nature in glomeruli of those that with diabetes after a few years of metabolic deformities.Chronic hyperglycemia as measured by mean blood glucose or HBA1c has been associated with the development and advancement of micro vascular diabetic complications. Methodology: This is a case control study done in the in-patient department of general medicine. From January to July 2014. The patients selected has a history of diabetes for more than 3 years and were on hypoglycemic agents/insulin. Diabetic nephropathy was confirmed by elevated levels of blood urea and serum creatinine, which has the level above 6.5 mg/dl. All patients had persistent increase in serum creatinine examinations and controlled cases are selected contingent on their normal creatinine and urea excretion profile. Results: the mean age of the patients with diabetic nephropathy is 54.43 ± 7.99 while the mean age of patients with control profile of diabetes were 48.37 ± 6.99. There were 22.9%, almost 23% of the patients with diabetic nephropathy are anemic. And the mean FBS levels in diabetic nephropathy in the current study were about180. 85 ± 42.05 and the mean exhibit by control groups 81.4 ± 7.0. While the mean HBA1C range in diabetic nephropathy patients was about 9.96 ± 5.07 and 4.45 ± 0.57 is the mean of the control group. The levels of blood urea, serum creatinine and triglycerides are evidently high, though which when compared to control group. Conclusion: HBA1c and FBS are the important predictors of intercapillary glomerulonephritis or diabetic nephropathy. HBA1c is highly co-related to preceding mean blood glucose. The chief outcome measures which predicts the intercapillary glomerulonephritis or diabetic glomerulosclerosis or diabetic nephropathy are HBA1c, triglycerides, serum creatinine and blood urea nitrogen. Patients with progressed nephropathy showed increased levels of serum triglycerides, which is the important independent clinical attribute.
Kidney International, 2006
Duration of diabetes is given in years. HbA 1c is the mean of all yearly HbA 1c until the first and second biopsy, respectively. HbA 1c between biopsies refers to the mean of yearly HbA 1c between the biopsies. The BMT have been corrected for 1.73 m 2 . The matrix/glom and mes/glom refers to the volume fraction of mesangial matrix in the glomerulus, V V (matrix/glom), and the volume fraction of the mesangium in the glomerulus, V V (mes/glom), in %. Only significant changes are given. a=median; b=mean. Kidney International (2006) 69, 699-705 701 NESS Perrin et al.: Serial kidney biopsies in type I diabetes patients o r i g i n a l a r t i c l e
The Oxford Classification of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as independent predictors of outcome. Whether it applies to individuals excluded from the original study and how therapy influences the predictive value of pathology remain uncertain. The VALIGA study examined 1147 patients from 13 European countries that encompassed the whole spectrum of IgAN. Over a median follow-up of 4.7 years, 86% received renin–angiotensin system blockade and 42% glucocorticoid/immunosuppressive drugs. M, S, and T lesions independently predicted the loss of estimated glomerular filtration rate (eGFR) and a lower renal survival. Their value was also assessed in patients not represented in the Oxford cohort. In individuals with eGFR less than 30 ml/min per 1.73 m2, the M and T lesions independently predicted a poor survival. In those with proteinuria under 0...
Prognostic Factors and Therapy Assessment of IgA Nephropathy: Report from a Single Unit in Iran
Renal Failure, 2011
Background: Immunoglobulin A (IgA) nephropathy is the most common cause of primary glomerulonephritis with slow progression to end-stage renal disease (ESRD) in up to 40% of patients. Methods: A retrospective cohort study of patients with biopsy-proven IgA nephropathy was performed in our center from 1998 to 2009. We tried to determine the clinical and pathological factors which affect patients progressing to ESRD. We also compared the impact of renin-angiotensin system (RAS) blockers therapy alone or in combination with prednisone on baseline proteinuria and glomerular filtration rate (GFR) after 6 months of treatment in patients with proteinuria>1 g/d and GFR>30 mL/min. Results: There were 70 IgA nephropathy patients of whom 46 were men. The average age of patients at biopsy was 39 ± 12.1 years. During the median 23.5 (6-130) months of follow-up, 10 patients progressed to ESRD and no patient died. Five-year renal survival following biopsy was 88%. By multivariate analysis, age more than 50 years (p = 0.003) and baseline serum creatinine level (p = 0.012) were independent predictors of progressing to ESRD and poor prognosis. Although there was no significant difference in proteinuria reduction after 6 months of treatment, kidney function was less preserved in RAS inhibitors therapy alone than in the combination treatment with prednisone. Conclusion: We showed that late diagnosis of patients with IgA nephropathy might be associated with poor outcome. Our results also suggest that addition of prednisone to RAS blockers may lead to better preservation of kidney function.
Predicting chronic renal insufficiency in idiopathic membranous glomerulonephritis
Kidney International, 1992
Predicting chronic renal insufficiency in idiopathic membranous gbmerulonephritis. We developed an approach in quantifying the risk of developing chronic renal insufficiency (CR1) based on a cohort of 184 patients with idiopathic membranous glomerulonephritis (IMGN), prospectively followed by the Toronto Glomerulonephritis Registry between 1974 and 1988. After a mean follow-up period of 5.8 years, 26% of patients developed CR1 (defined as persistent reduction of creatinine clearance (Car) 60 mI/min/! .73 m2 for 12 months). We found that when compared to the baseline probability of the unselected patients, the severity of proteinuria at kidney biopsy added only marginally to the prediction of CR1. We introduced a special test condition: persistent proteinuria (PP) (that is, duration of proteinuria, g/day, above different cut-off levels). We examined the positive predictive value (PPV) and sensitivity (SEN) of 15 arbitrarily chosen levels of PP (that is, proteinuria 4, 6 or 8 glday persisting for 9, 12, 18 or 24 months) to select levels with optimal predictive characteristics. We found that PP 8 g/day for six months was a simple and useful predictor of CR1 with a PPV and SEN of 66%. To further improve our prediction, we tested the following parameters: age, sex, initial Sr and proteinuria, serum albumin, hypertension, rate of change of Cr over time, and therapy (steroids immunosuppressive drugs) in a multivariate analysis. Proteinuria, initial C, and rate of change of C. were most important in predicting CR1. Fifteen models were then developed by including each patient's Cr at the start of PP and its rate of change during the time period selected. Two models based on PP 4 g/day for 18 months, or 6 g/day for 9 months significantly improved the PPV's for CR1 from those based on the same levels of PP alone. Using these test conditions, we can improve the prediction of CR1 from a baseline probability of 26% in unselected patients to a range of 55 to 86% in the "high-risk" patients (with SEN > 60%). Application of these predictive strategies in IMGN will be useful in managing the individual patients and in selecting patients for clinical trials by limiting the exposure of potentially toxic therapy to the "high-risk" patients.
A validated model of disease progression in IgA nephropathy
Journal of nephrology
IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the general population. There is accumulating evidence that immunosuppressive treatment is efficacious in IgAN. However, it is critical to define appropriate indicators for this therapy especially in the wake of potentially deleterious side effects to immunosuppressives. This study retrospectively reviewed IgAN cases collected since 1981 to identify clinical and/or histological parameters for disease progression; 310 patients with biopsy proven IgAN, diagnosed from January 1981 to March 2004, were included. We defined a clinical prognostic index (CPI) using multivariate analysis, which incorporated these clinical/ histological parameters. Semiquantitative scores were assigned as follows: 2 points if creatinine (Cr) was >1.4 mg/dL, 1 point if proteinuria was >1 g/24 hr, 1 point if a patient was affected by hypertension, and 1 point if a patient was older than 30 yrs. Dividing our population into two groups ...