Risk Stratification of Patients With IgA Nephropathy

• Published in: American journal of kidney diseases Vol. 59; no. 6; pp. 865 - 873
• Main Authors: Barbour, Sean J., MD, FRCPC, Reich, Heather N., MD, CM, PhD, FRCPC
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier
• Subjects: Biological and medical sciences; Cause of Death; Disease Progression; Female; Follow-Up Studies; Glomerular Filtration Rate - physiology; Glomerulonephritis; Glomerulonephritis, IGA - mortality; Glomerulonephritis, IGA - physiopathology; Glomerulonephritis, IGA - therapy; Humans; Hypertension - epidemiology; Hypertension - physiopathology; Immunoglobulin A nephropathy; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Male; Medical sciences; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; pathology; prognosis; proteinuria; Proteinuria - epidemiology; Proteinuria - physiopathology; Renal Dialysis - methods; Renal Dialysis - mortality; Risk Assessment; risk factor; Severity of Illness Index; Survival Analysis; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Immunoglobulin A nephropathy; pathology; prognosis; risk factor; proteinuria; Kidney disease; Human; Immunopathology; Nephrology; Urinary system disease; Prognosis; Epidemiology; Urology; Anatomic pathology; Risk factor; IgA glomerular nephropathy; Proteinuria
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2012.02.326

In this review, we summarize recent advances in the risk stratification of patients with immunoglobulin A (IgA) nephropathy. Several clinical variables have consistent and independent associations with worse kidney prognosis, including blood pressure, proteinuria, and baseline kidney function. Although one-time cross-sectional assessments of blood pressure and proteinuria are important, a more thorough understanding of risk can be achieved when these variables are considered over a follow-up period. IgA nephropathy is unique compared with other glomerular diseases in that a much lower threshold of proteinuria (protein excretion, 1 g/d) is associated with glomerular filtration rate (GFR) loss. Controlling proteinuria and blood pressure over time is important to reduce the risk of future loss of kidney function. The recently described Oxford classification has helped standardize the pathologic characterization of IgA nephropathy using a scoring system that is readily reproducible and associated with increased risk of GFR loss independent of clinical variables. We suggest an approach to risk stratification in IgA nephropathy when considering potential treatment with immunosuppression. Despite our current understanding of risk stratification in IgA nephropathy, the ability to accurately predict individual patient-level risk currently is limited, and further research into additional biomarkers or risk prediction tools is needed to improve the care of patients with IgA nephropathy.