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01-04-2016 | Original Article

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

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

Published in: Clinical and Experimental Nephrology | Issue 2/2016

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.

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Title: Clinicopathological characteristics of patients with immunoglobulin A nephropathy showing acute exacerbations after favorable long-term clinical courses
Authors: Mai Tanaka
Yoichi Miyazaki
Kentaro Koike
Hiroyuki Ueda
Nobuo Tsuboi
Keita Hirano
Hideo Okonogi
Makoto Ogura
Tetsuya Kawamura
Takashi Yokoo
Publication date: 01-04-2016
Publisher: Springer Japan
Published in: Clinical and Experimental Nephrology / Issue 2/2016
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI: https://doi.org/10.1007/s10157-015-1153-8

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Abstract

Background

Methods

Results

Conclusion

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