What Are the Main Risk Factors for the Progression of IgA Nephropathy to Kidney Failure
What are the main risk factors for the progression of IgA Nephropathy to Chronic Kidney Failure? It is particularly important for the establishment of IgA nephropathy treatment plan, delaying the progress of disease and preventing the occurrence of adverse prognosis.
Proteinuria is one of the recognized prognostic indicators of IgA nephropathy. Many studies have identified 24-hour urinary protein quantification greater than 1g as an independent risk factor for disease progression, and 1g/day as the severity of proteinuria. In a retrospective study, a follow-up study of 1012 patients with IgA nephropathy found that 24-hour urinary protein increase was an independent risk factor for the progression of IgA nephropathy to ESRD, whereas 24-hour urinary protein quantification < 0.5g had little risk for the progression of ESRD. A retrospective study in China showed that the risk of end-stage renal disease in IgA nephropathy patients with average time urinary protein quantification > 1g was 9.4 times higher than that in IgA nephropathy patients with urinary protein quantification < 1g and 46.5 times higher than that in IgA nephropathy patients with urinary protein quantification < 0.5g. The prognosis of 24-hour urinary protein quantification > 3g was worse. The glomerular filtration rate decreased by 9 ml/min/1.73 m2 in the next year, and the progression rate of kidney disease was 25 times that of 24-hour urinary protein quantification < 1g. During the follow-up period, 24-hour urinary protein quantification was less alkaline, and the deterioration rate of renal function would decrease. Studies have shown that when patients with initial 24-hour urinary protein quantification > 3g have remission and urinary protein quantification is less than 1g, the prognosis is similar to that of 24-hour urinary protein quantification < 1g. Therefore, the International KDIGO Guidelines recommend that 24-hour urinary protein quantification of 1g be used as a threshold for assessing the severity of IgA nephropathy.
2. Renal function
Renal function is generally considered to represent the degree of kidney damage, so the relationship between renal function and prognosis is the greatest. In a study with an average follow-up time of 11.8 years, we found that the mortality risk of IgA nephropathy patients with eGFR < 60 ml/min/1.73 M2 increased by 1.9 times and that of IgA nephropathy patients with eGFR < 30 ml/min/1.73 M2 increased by 3.6 times. In a retrospective study of 2269 patients with IgA nephropathy, renal function was closely related to ESRD within seven years. Only 2.5% of patients with serum creatinine level < 1.25 mg/dl (110.5 umol/L) entered ESRD within seven years. The incidence of serum creatinine was 26% in 1.26-1.67 mg/dl (111.4-147.6 umol/L), while 71% of patients with serum creatinine > 1.68 mg/dl (148.5 umol/L) progressed to ESRD. When the serum creatinine level exceeds 3 mg/dl (265 umol/L), most scholars think that this may be the non-regression point of IgA nephropathy, and even some scholars think that the non-regression point is 2 mg/dl (177 umol/L). However, because the relationship between basic renal function and glomerular filtration rate is still uncertain, the incidence of IgA nephropathy also has acute and chronic processes, so it is necessary to judge whether renal failure is progressing or not. To observe the changes of renal function, a comprehensive assessment of proteinuria, blood pressure and pathological characteristics of the kidney is needed.
Hypertension is a common complication of IgA nephropathy. It has obvious effect on kidney tissue. In the early stage, it mainly affects the function of renal tubule and abnormal urine concentration function. It can cause renal arteriosclerosis, wall thickening and lumen narrowing for a long time, and then secondary ischemic damage of renal parenchyma, especially malignant hypertension, which can lead to malignant arteriosclerosis of small and medium arteries and quickly enter renal failure. A long-term prognosis study of 1155 patients with IgA nephropathy found that hypertension was an independent risk factor for progression to ESRD. IgA nephropathy patients with blood pressure greater than 130/80 mmHg had a 2.5 times of risk of entering ESRD or eGFR decreasing by more than 50% compared with IgA nephropathy patients with blood pressure less than 130/80 mmHg. In a retrospective study of 400 patients with IgA nephropathy, 45% had hypertension, and these patients were at greater risk of dialysis or death. The main characteristic of malignant hypertensive renal damage is impaired renal function. The prognosis of IgA nephropathy with malignant hypertensive renal damage seems worse. Others have followed up 347 patients with IgA nephropathy and found that hypertension is the only factor associated with poor prognosis in patients with normal initial renal function. Strict blood pressure control can improve the prognosis of patients with IgA nephropathy complicated with hypertension.
In conclusion, there are many risk factors affecting prognosis of IgA Nephropathy. Besides the above three factors, high uric acid level, high creatinine level, glomerular sclerosis and renal interstitial fibrosis and so on can also affect the prognosis. For more information, please leave a message below or contact online doctor.
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