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IgA nephropathy in Brazil: apropos of 600 cases.

Soares MF, Caldas ML, Dos-Santos WL, Sementilli A, Furtado P, Araújo S, Pegas KL, Petterle RR, Franco MF - Springerplus (2015)

Bottom Line: Male to female ratio was 1.24:1.To the best of our knowledge this is the largest series of IgAN in Brazil.Our set of data is comparable to previous reports.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; Department of Medical Pathology, Federal University of Paraná (UFPR), Curitiba, Brazil ; Brazilian Kidney Club, Brazilian Society of Pathology (SBP), São Paulo, Brazil ; Departamento de Patologia Médica, Rua Padre Camargo, 280, 6. andar, Curitiba, PR 80060-240 Brazil.

ABSTRACT
IgA nephropathy (IgAN) is th e commonest primary glomerular disease worldwide. Studies on its prevalence in Brazil are however scarce. Databases and clinical records from 10 reference centres were retrospectively reviewed. Clinical and laboratory features at the moment of the biopsy were retrieved (age, gender, presence of hematuria, serum creatinine [mg/dL], proteinuria [g/24 h]). Renal biopsy findings were classified according to Haas single grade classification scheme and the Oxford Classification of IgAN. 600 cases of IgAN were identified, of which 568 (94.7 %) were on native kidneys. Male to female ratio was 1.24:1. Patients averaged 32.76 ± 15.12 years old (range 4-89, median 32). Proteinuria and hematuria were observed, respectively in 56.63 and 72.29 % of patients. The association of both these findings occurred in 37.95 % of the cases. Serum creatinine averaged 1.65 ± 0.67 mg/dL (median 1.5 mg/dL) at diagnosis. Segmental sclerosis and mesangial hypercellularity were the main glomerular findings (47.6 and 46.2 %) The commonest combination by Oxford Classification of IgAN, was M0 E0 S0 T0 (22.4 %). Chronic tubulo-interstitial lesions with an extension wider than 25 % of the renal cortex could be identified in 32.2 % of the cases. Tubular atrophy and interstitial fibrosis were more strongly associated with higher 24-h proteinuria and serum creatinine levels. Segmental sclerosis (S1) showed a stronger tendency of association with the presence of tubulo-interstitial lesions (T1 and T2) than other glomerular variables. To the best of our knowledge this is the largest series of IgAN in Brazil. It depicts the main biopsy findings and their possible clinical correlates. Our set of data is comparable to previous reports.

No MeSH data available.


Related in: MedlinePlus

Serum creatinine (mg/dL) values according to Oxford classification. M mesangial hypercellularity (0 absent; 1 present); E endocapillary proliferation (0 absent; 1 present); S segmental sclerosis/adhesions/synechiae (0 absent; 1 present); T tubular atrophy/interstitial fibrosis (0–0–25 %; 1–26–50 %; 2 to >50 %)
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Fig2: Serum creatinine (mg/dL) values according to Oxford classification. M mesangial hypercellularity (0 absent; 1 present); E endocapillary proliferation (0 absent; 1 present); S segmental sclerosis/adhesions/synechiae (0 absent; 1 present); T tubular atrophy/interstitial fibrosis (0–0–25 %; 1–26–50 %; 2 to >50 %)

Mentions: Wilcoxon rank sum test and Kruskal–Wallis rank sum test were performed to test if any of the Oxford classification variables were more strongly associated with laboratory data. A trend towards higher 24-h proteinuria levels was observed in patients whose biopsies revealed mesangial hypercellularity (Oxford M0 = 2.35 ± 2.08 g/24 h vs. Oxford M1 = 3.51 ± 2.99 g/24 h; P = 0.06). The presence of moderate tubular atrophy and interstitial fibrosis was associated with higher levels of 24-h proteinuria (Oxford T0 = 2.14 ± 1.85 g/24 h vs. Oxford T1 = 3.09 ± 2.66 g/24 h; P < 0.001). However, no significant differences were found regarding 24-h proteinuria levels when comparing Oxford T0 and T2 (3.02 ± 2.07 g/24 h) or Oxford T1 with T2 (P = 0.22 and 0.20) (Fig. 1). Regarding serum creatinine levels the more extensive the tubular atrophy and interstitial fibrosis the higher the serum creatinine levels (Oxford T0 = 1.45 ± 0.67 mg/dL; Oxford T1 = 1.61 ± 0.72 mg/dL; Oxford T2 = 3.55 ± 1.98 mg/dL; T0 vs. T2 P < 0.001; T1 vs. T2 P = 0.04). However patients with moderate tubular atrophy and interstitial fibrosis did not show higher serum creatinine levels when compared to patients with none to mild changes (Oxford T1 vs. T0, P = 0.13) (Fig. 2). The abovementioned results indicate that tubulo-interstitial but not glomerular variables were associated with worst laboratory parameters—24-h proteinuria and higher serum creatinine levels. We found out that when all glomerular variables equaled zero (M0, E0 and S0), T equaled zero (T0) in a significantly higher frequency than that of T1 or T2 cases (22.38 vs. 6.39 %, P = 4.475e−09). Thus, to test if any single glomerular variable was more frequently associated with the presence of chronic tubulo-interstitial lesions (T ≠ 0) we carried out Fisher’s exact test. None of the glomerular variables was more frequently associated to the presence of tubular atrophy and interstitial fibrosis (Oxford T1 and T2). However upon the presence of segmental sclerosis (S1) there was a slight trend towards a higher frequency of T1 and T2 lesions (M0 E0 S1 T0 = 14.8 %; M0 E0 S1 T ≠ 0 = 7.8 %; P = 0.09). This trend could not be proved for M1 and E1 lesions (M1 E0 S0 T0 = 11.9 %; M1 E0 S0 T ≠ 0 = 3.8 %; P = 0.84/M0 E1 S0 T0 = 0.9 %; M0 E1 S0 T ≠ 0 = 0.9 %; P = 0.15). These figures are summarised on Table 1.Fig. 1


IgA nephropathy in Brazil: apropos of 600 cases.

Soares MF, Caldas ML, Dos-Santos WL, Sementilli A, Furtado P, Araújo S, Pegas KL, Petterle RR, Franco MF - Springerplus (2015)

Serum creatinine (mg/dL) values according to Oxford classification. M mesangial hypercellularity (0 absent; 1 present); E endocapillary proliferation (0 absent; 1 present); S segmental sclerosis/adhesions/synechiae (0 absent; 1 present); T tubular atrophy/interstitial fibrosis (0–0–25 %; 1–26–50 %; 2 to >50 %)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4582041&req=5

Fig2: Serum creatinine (mg/dL) values according to Oxford classification. M mesangial hypercellularity (0 absent; 1 present); E endocapillary proliferation (0 absent; 1 present); S segmental sclerosis/adhesions/synechiae (0 absent; 1 present); T tubular atrophy/interstitial fibrosis (0–0–25 %; 1–26–50 %; 2 to >50 %)
Mentions: Wilcoxon rank sum test and Kruskal–Wallis rank sum test were performed to test if any of the Oxford classification variables were more strongly associated with laboratory data. A trend towards higher 24-h proteinuria levels was observed in patients whose biopsies revealed mesangial hypercellularity (Oxford M0 = 2.35 ± 2.08 g/24 h vs. Oxford M1 = 3.51 ± 2.99 g/24 h; P = 0.06). The presence of moderate tubular atrophy and interstitial fibrosis was associated with higher levels of 24-h proteinuria (Oxford T0 = 2.14 ± 1.85 g/24 h vs. Oxford T1 = 3.09 ± 2.66 g/24 h; P < 0.001). However, no significant differences were found regarding 24-h proteinuria levels when comparing Oxford T0 and T2 (3.02 ± 2.07 g/24 h) or Oxford T1 with T2 (P = 0.22 and 0.20) (Fig. 1). Regarding serum creatinine levels the more extensive the tubular atrophy and interstitial fibrosis the higher the serum creatinine levels (Oxford T0 = 1.45 ± 0.67 mg/dL; Oxford T1 = 1.61 ± 0.72 mg/dL; Oxford T2 = 3.55 ± 1.98 mg/dL; T0 vs. T2 P < 0.001; T1 vs. T2 P = 0.04). However patients with moderate tubular atrophy and interstitial fibrosis did not show higher serum creatinine levels when compared to patients with none to mild changes (Oxford T1 vs. T0, P = 0.13) (Fig. 2). The abovementioned results indicate that tubulo-interstitial but not glomerular variables were associated with worst laboratory parameters—24-h proteinuria and higher serum creatinine levels. We found out that when all glomerular variables equaled zero (M0, E0 and S0), T equaled zero (T0) in a significantly higher frequency than that of T1 or T2 cases (22.38 vs. 6.39 %, P = 4.475e−09). Thus, to test if any single glomerular variable was more frequently associated with the presence of chronic tubulo-interstitial lesions (T ≠ 0) we carried out Fisher’s exact test. None of the glomerular variables was more frequently associated to the presence of tubular atrophy and interstitial fibrosis (Oxford T1 and T2). However upon the presence of segmental sclerosis (S1) there was a slight trend towards a higher frequency of T1 and T2 lesions (M0 E0 S1 T0 = 14.8 %; M0 E0 S1 T ≠ 0 = 7.8 %; P = 0.09). This trend could not be proved for M1 and E1 lesions (M1 E0 S0 T0 = 11.9 %; M1 E0 S0 T ≠ 0 = 3.8 %; P = 0.84/M0 E1 S0 T0 = 0.9 %; M0 E1 S0 T ≠ 0 = 0.9 %; P = 0.15). These figures are summarised on Table 1.Fig. 1

Bottom Line: Male to female ratio was 1.24:1.To the best of our knowledge this is the largest series of IgAN in Brazil.Our set of data is comparable to previous reports.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; Department of Medical Pathology, Federal University of Paraná (UFPR), Curitiba, Brazil ; Brazilian Kidney Club, Brazilian Society of Pathology (SBP), São Paulo, Brazil ; Departamento de Patologia Médica, Rua Padre Camargo, 280, 6. andar, Curitiba, PR 80060-240 Brazil.

ABSTRACT
IgA nephropathy (IgAN) is th e commonest primary glomerular disease worldwide. Studies on its prevalence in Brazil are however scarce. Databases and clinical records from 10 reference centres were retrospectively reviewed. Clinical and laboratory features at the moment of the biopsy were retrieved (age, gender, presence of hematuria, serum creatinine [mg/dL], proteinuria [g/24 h]). Renal biopsy findings were classified according to Haas single grade classification scheme and the Oxford Classification of IgAN. 600 cases of IgAN were identified, of which 568 (94.7 %) were on native kidneys. Male to female ratio was 1.24:1. Patients averaged 32.76 ± 15.12 years old (range 4-89, median 32). Proteinuria and hematuria were observed, respectively in 56.63 and 72.29 % of patients. The association of both these findings occurred in 37.95 % of the cases. Serum creatinine averaged 1.65 ± 0.67 mg/dL (median 1.5 mg/dL) at diagnosis. Segmental sclerosis and mesangial hypercellularity were the main glomerular findings (47.6 and 46.2 %) The commonest combination by Oxford Classification of IgAN, was M0 E0 S0 T0 (22.4 %). Chronic tubulo-interstitial lesions with an extension wider than 25 % of the renal cortex could be identified in 32.2 % of the cases. Tubular atrophy and interstitial fibrosis were more strongly associated with higher 24-h proteinuria and serum creatinine levels. Segmental sclerosis (S1) showed a stronger tendency of association with the presence of tubulo-interstitial lesions (T1 and T2) than other glomerular variables. To the best of our knowledge this is the largest series of IgAN in Brazil. It depicts the main biopsy findings and their possible clinical correlates. Our set of data is comparable to previous reports.

No MeSH data available.


Related in: MedlinePlus