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Proposal of remission criteria for IgA nephropathy

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Abstract

Background

The remission criteria of immunoglobulin A (IgA) nephropathy have varied depending on the clinical study. Therefore, nephrologists cannot make a uniform assessment of treatment outcomes and the standardization of explanations of the condition is difficult in patients with IgA nephropathy. This study aims to propose clinical remission criteria for IgA nephropathy based on a nationwide opinion survey in Japan regarding IgA nephropathy remission/relapse.

Method

This nationwide survey was sent to 312 teaching facilities of the Japanese Society of Nephrology by Progressive Renal Disease Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.

Results

Valid answers were obtained from 193 facilities (61.9 %) (136 internal medicine facilities and 57 pediatric facilities), of which 134 (69.4 %) thought that both hematuria and proteinuria should be used in the remission standards. Approximately half of the survey respondents shared the opinion on standards of negative results for hematuria and proteinuria and the duration and frequency of these conditions.

Conclusion

In this paper, we propose a standardized set of criteria for defining IgA nephropathy remission: three consecutive negative results over a 6-month period in urinary occult blood tests; urinary sediment red blood cell count of <5/high-power field (hematuria remission); and urinary protein of <0.3 g/day (g/g Cr; proteinuria remission). Clinical remission is defined as cases with both hematuria and proteinuria remission. These consensus-based remission criteria should be verified in future studies. In the meantime, they may be useful in predicting therapeutic outcome in cases of IgA nephropathy.

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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. Pozzi C, Bolasco PG, Fogazzi GB, et al. Corticosteroids in IgA nephropathy: a randomised controlled trial. Lancet. 1999;353:883–7.

    Article  CAS  PubMed  Google Scholar 

  3. Hotta O, Miyazaki M, Furuta T, et al. 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 

  4. Matsuzaki K, Suzuki Y, Nakata J et al. Nationwide survey on current treatments for IgA nephropathy in Japan. Clin Exp Nephrol. 2013 (epub ahead of print). http://link.springer.com/content/pdf/10.1007%2Fs10157-013-0779-7. Accessed 22 March 2013.

  5. Reich HN, Troyanov S, Scholey JW, et al. Remission of proteinuria improves prognosis in IgA nephropathy. J Am Soc Nephrol. 2007;18:3177–83.

    Article  CAS  PubMed  Google Scholar 

  6. Hwang HS, Kim BS, Shin YS, et al. Predictors for progression in immunoglobulin A nephropathy with significant proteinuria. Nephrology. 2010;15:236–41.

    Article  PubMed  Google Scholar 

  7. Tatematsu M, Yasuda Y, Morita Y, et al. Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol. 2012;16:883–91.

    Article  CAS  PubMed  Google Scholar 

  8. Imai E, Horio M, Yamagata K, et al. Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study. Hypertens Res. 2008;31:433–41.

    Article  PubMed  Google Scholar 

  9. Iseki K, Tokashiki K, Iseki C, et al. Proteinuria and the risk of developing end-stage renal disease. Kidney Int. 2003;63:1468–74.

    Article  PubMed  Google Scholar 

  10. Pozzi C, Andrulli S, Del Vecchio L, et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol. 2004;15:157–63.

    Article  CAS  PubMed  Google Scholar 

  11. Li PK, Leung CB, Chow KM, et al. Hong Kong study using valsartan in IgA nephropathy (HKVIN): a double-blind, randomized, placebo-controlled study. Am J Kidney Dis. 2006;47:751–60.

    Article  CAS  PubMed  Google Scholar 

  12. Endo M. Epidemiology and prognosis of IgA nephropathy. Nihon Jinzo Gakkai Shi. 2008;50:442–7.

    PubMed  Google Scholar 

  13. Goto M, Wakai K, Kawamura T, et al. A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study. Nephrol Dial Transpl. 2009;24:3068–74.

    Article  Google Scholar 

  14. Szeto CC, Lai FM, To KF, et al. 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 

  15. Shen P, He L, Li Y, et al. Natural history and prognostic factors of IgA nephropathy presented with isolated microscopic hematuria in Chinese patients. Nephron Clin Pract. 2007;106(4):c157–61.

    Article  CAS  PubMed  Google Scholar 

  16. Scientific Committee, Japanese Society of Nephrology. Evidence-based practice guideline for the treatment of CKD. Tokyo: Tokyo Igakusya; 2009.

    Google Scholar 

  17. Commitee for Diagnostic Guidelines of Hematuria. Guidelines for diagnosis of hematuria. Nihon Jinzo Gakkai Shi. 2006;48(Suppl):1–34.

    Google Scholar 

  18. Committee of revision of clinical practice guidebook 2012 for diagnosis and treatment of CKD. Clinical practice guidebook for diagnosis and treatment of chronic kidney disease 2012. Tokyo: Tokyo Igakusha; 2012.

    Google Scholar 

  19. Japanese Society of Nephrology. Nephrotic syndrome diagnosis guidelines. Nihon Jinzo Gakkai Shi. 2011;53:78–122.

    Google Scholar 

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Acknowledgments

We thank the fellows of the Japanese Society of Nephrology who responded to our questionnaire. This study was supported in a part by a Grant-in Aid for Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan. The authors are grateful to F. Shimazawa and E. Katayama of Juntendo University, Faculty of Medicine for their excellent clerical assistance.

Conflict of interest

The authors have declared that no conflict of interest exists.

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Correspondence to Yusuke Suzuki.

Additional information

For the Special IgA Nephropathy Study Group in Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.

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Suzuki, Y., Matsuzaki, K., Suzuki, H. et al. Proposal of remission criteria for IgA nephropathy. Clin Exp Nephrol 18, 481–486 (2014). https://doi.org/10.1007/s10157-013-0849-x

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  • DOI: https://doi.org/10.1007/s10157-013-0849-x

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