Skip to main content
SpringerLink
Log in

Clinicopathological characteristics of patients with immunoglobulin A nephropathy showing acute exacerbations after favorable long-term clinical courses

  • Original Article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Sometimes, acute and progressive proteinuria increases occur in patients with IgA nephropathy (IgAN) after favorable long-term clinical courses of >10 years, but their clinical and histological characteristics are not well understood.

Methods

We retrospectively selected 20 IgAN patients who had been followed for >10 years after their initial biopsies (1stBx) and underwent second biopsies (2ndBx), because their proteinuria increased to >1 g/day. Eight patients with acute exacerbations (Group A) showed acute proteinuria increases after long periods of mild proteinuria. Their clinicopathological characteristics were analyzed as a case series and were compared with those in Group B that comprised 12 patients with persistent proteinuria.

Results

Group A experienced acute proteinuria increases and significant hematuria increases compared with the −1-year (P = 0.006) and −3-year (P = 0.010) time points before the 2ndBx, which contrasted to the clinical course in Group B. In Group A, glomerulosclerosis (GS) and the arteriosclerosis score did not differ between the 2ndBx and the 1stBx, and most patients (88 %) showed cellular and/or fibrocellular crescents within the 2ndBx. Compared with Group B, the 2ndBx revealed that the percentage of cellular and/or fibrocellular crescents (P = 0.001) was significantly higher, whereas the percentage of GS (P = 0.012) and the arteriosclerosis score (P = 0.020) were significantly lower in Group A.

Conclusion

Rapid proteinuria and hematuria increases, and acute histological lesions characterize acute exacerbations in IgAN after favorable long-term clinical courses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Koyama A, Igarashi M, Kobayashi M. Natural history and risk factors for immunoglobulin A nephropathy in Japan. Research Group on Progressive Renal Diseases. Am J Kidney Dis. 1997;29:526–32.

    Article  CAS  PubMed  Google Scholar 

  2. D’Amico G. Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome. Semin Nephrol. 2004;24:179–96.

    Article  PubMed  Google Scholar 

  3. Szeto CC, Lai FM, To KF, Wong TY, Chow KM, Choi PC, Lui SF, Li PK. The natural history of immunoglobulin a nephropathy among patients with hematuria and minimal proteinuria. Am J Med. 2001;110:434–7.

    Article  CAS  PubMed  Google Scholar 

  4. Chauveau D, Droz D. Follow-up evaluation of the first patients with IgA nephropathy described at Necker hospital. Contrib Nephrol. 1993;104:1–5.

    Article  CAS  PubMed  Google Scholar 

  5. Galla JH. IgA nephropathy. Kidney Int. 1995;47:377–87.

    Article  CAS  PubMed  Google Scholar 

  6. D’Amico G. Natural history of idiopathic IgA nephropathy: role of clinical and histological prognostic factors. Am J Kidney Dis. 2000;36:227–37.

    Article  PubMed  Google Scholar 

  7. Katafuchi R, Ninomiya T, Nagata M, Mitsuiki K, Hirakata H. Validation study of Oxford classification of IgA nephropathy: the significance of extracapillary proliferation. Clin J Am Soc Nephrol. 2011;6:2806–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Kawamura T, Joh K, Okonogi H, Koike K, Utsunomiya Y, Miyazaki Y, Matsushima M, Yoshimura M, Horikoshi S, Suzuki Y, Furusu A, Yasuda T, Shirai S, Shibata T, Endoh M, Hattori M, Katafuchi R, Hashiguchi A, Kimura K, Matsuo S, Tomino Y. Study Group Special IgA Nephropathy. A histologic classification of IgA nephropathy for predicting long-term prognosis: emphasis on end-stage renal disease. J Nephrol. 2013;26:350–7.

    Article  CAS  PubMed  Google Scholar 

  9. Reich HN, Troyanov S, Scholey JW, Cattran DC. Toronto glomerulonephritis registry. Remission of proteinuria improves prognosis in IgA nephropathy. J Am Soc Nephrol. 2007;18:3177–83.

    Article  CAS  PubMed  Google Scholar 

  10. Frimat L, Briançon S, Hestin D, Aymard B, Renoult E, Huu TC, Kessler M. IgA nephropathy: prognostic classification of end-stage renal failure. L’Association des Néphrologues de l’Est. Nephrol Dial Tranplant. 1997;12:2569–75.

    Article  CAS  Google Scholar 

  11. Barratt J, Feehally J. Treatment of IgA nephropathy. Kidney Int. 2006;69:1934–8.

    Article  CAS  PubMed  Google Scholar 

  12. Hostetter TH. Hyperfiltration and glomerulosclerosis. Semin Nephrol. 2003;23:194–9.

    Article  CAS  PubMed  Google Scholar 

  13. Helal I, Fick-Brosnahan GM, Reed-Gitomer B, Schrier RW. Glomerular hyperfiltration: definitions, mechanisms and clinical implications. Nat Rev Nephrol. 2012;8:293–300.

    Article  CAS  PubMed  Google Scholar 

  14. Sakai K, Saneshige M, Takasu J, Yanagisawa T, Aoki Y, Kawamura T, Mizuiri S, Aikawa A. Clinical remission and pathological progression after tonsillectomy in a renal transplant patient with recurrent IgA nephropathy. Clin Transplant. 2009;23(Suppl 20):44–8.

    Article  PubMed  Google Scholar 

  15. Kennoki T, Ishida H, Yamaguchi Y, Tanabe K. Proteinuria-reducing effects of tonsillectomy alone in IgA nephropathy recurring after kidney transplantation. Transplantation. 2009;88:935–41.

    Article  PubMed  Google Scholar 

  16. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A. Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  PubMed  Google Scholar 

  17. Working Group of the International IgA Nephropathy Network and the Renal Pathology Society. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int. 2009;76:546–56.

  18. Utsunomiya Y, Kawamura T, Abe A, Imai H, Hirano K, Maruyama N, Hosoya T, Sakai O. Significance of mesangial expression of alpha-smooth muscle actin in the progression of IgA nephropathy. Am J Kidney Dis. 1999;34:902–10.

    Article  CAS  PubMed  Google Scholar 

  19. Tsuboi N, Utsunomiya Y, Kanzaki G, Koike K, Ikegami M, Kawamura T, Hosoya T. Low glomerular density with glomerulomegaly in obesity-related glomerulopathy. Clin J Am Soc Nephrol. 2012;7:735–41.

    Article  PubMed  Google Scholar 

  20. Ohya M, Otani H, Minami Y, Yamanaka S, Mima T, Negi S, Yukawa S, Shigematsu T. Tonsillectomy with steroid pulse therapy has more effect on the relapse rate than steroid pulse monotherapy in IgA nephropathy patients. Clin Nephrol. 2013;80:47–52.

    Article  CAS  PubMed  Google Scholar 

  21. Shen P, He L, Li Y, Wang Y, Chan M. Natural history and prognostic factors of IgA nephropathy presented with isolated microscopic hematuria in Chinese patients. Nephron Clin Pract. 2007;106:c157–61.

    Article  CAS  PubMed  Google Scholar 

  22. Hotta O, Miyazaki M, Furuta T, Tomioka S, Chiba S, Horigome I, Abe K, Taguma Y. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001;38:736–43.

    Article  CAS  PubMed  Google Scholar 

  23. Miura N, Imai H, Kikuchi S, Hayashi S, Endoh M, Kawamura T, Tomino Y, Moriwaki K, Kiyomoto H, Kohagura K, Nakazawa E, Kusano E, Mochizuki T, Nomura S, Sasaki T, Kashihara N, Soma J, Tomo T, Nakabayashi I, Yoshida M, Watanabe T. Tonsillectomy and steroid pulse (TSP) therapy for patients with IgA nephropathy: a nationwide survey of TSP therapy in Japan and an analysis of the predictive factors for resistance to TSP therapy. Clin Exp Nephrol. 2009;13:460–6.

    Article  CAS  PubMed  Google Scholar 

  24. Kawaguchi T, Ieiri N, Yamazaki S, Hayashino Y, Gillespie B, Miyazaki M, Taguma Y, Fukuhara S, Hotta O. Clinical effectiveness of steroid pulse therapy combined with tonsillectomy in patients with immunoglobulin A nephropathy presenting glomerular haematuria and minimal proteinuria. Nephrology (Carlton). 2010;15:116–23.

    Article  CAS  Google Scholar 

  25. Bazzi C, Rizza V, Raimondi S, Casellato D, Napodano P, D’Amico G. In crescentic IgA nephropathy, fractional excretion of IgG in combination with nephron loss is the best predictor of progression and responsiveness to immunosuppression. Clin J Am Soc Nephrol. 2009;4:929–35.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kidney Disease Improving Global Outcomes (KDIGO). KDIGO Clinical Practice Guideline for Glomerulonephritis. Chapter 10: Immunoglobulin A nephropathy. Kidney Int Suppl. 2012;2:209–17.

Download references

Acknowledgments

This study was supported in part by a Grant-in-Aid for Progressive Renal Diseases Research from Japan’s Ministry of Health, Labour and Welfare.

Author information

Authors and Affiliations

  1. Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan

    Mai Tanaka, Yoichi Miyazaki, Kentaro Koike, Hiroyuki Ueda, Nobuo Tsuboi, Keita Hirano, Hideo Okonogi, Makoto Ogura, Tetsuya Kawamura & Takashi Yokoo

Authors
  1. Mai Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoichi Miyazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kentaro Koike
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroyuki Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuo Tsuboi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keita Hirano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hideo Okonogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Makoto Ogura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tetsuya Kawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takashi Yokoo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoichi Miyazaki.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 64 kb)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanaka, M., Miyazaki, Y., Koike, K. et al. Clinicopathological characteristics of patients with immunoglobulin A nephropathy showing acute exacerbations after favorable long-term clinical courses. Clin Exp Nephrol 20, 226–234 (2016). https://doi.org/10.1007/s10157-015-1153-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-015-1153-8

Keywords

Search

Navigation