Hyeon Tae Yang, Tae In Park, Yong-Jin Kim, Mee-Seon Kim, Sun-Hee Park, Jeong-Hoon Lim, Yoo Na Kang, DongJa Kim, Man-Hoon Han
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Therefore, this retrospective study conducted at Kyungpook National University Hospital between October 2016 and December 2021, aimed to elucidate the significance of intrarenal vascular lesions in IgAN by comparing the clinical data of patients with and without such lesions.</p><p><strong>Methods: </strong>Data of patients with biopsy-confirmed primary IgAN between October 2016 and June 2021 at Kyungpook National University Hospital (Daegu, South Korea) were collected, and their medical records were reviewed. All slides from these 138 cases were independently pathologically reviewed by two nephropathologists (Y. J. K. and M. S. K.) using light microscope. The vascular lesions included in this study were fibrous intimal thickening, arteriolar wall thickening, and arteriolar hyalinosis. All cases were reviewed according to the Oxford Classification of IgA Nephropathy (2016) and Haas classification.</p><p><strong>Results: </strong>Of the 138 patients, 88 exhibited at least one intrarenal vascular lesion. Patients with arteriolar wall thickening demonstrated a reduced estimated glomerular filtration rate (eGFR), elevated serum creatinine level and urine protein-to-creatinine ratio, an increased proportion of global glomerulosclerosis, and a higher histologic grade of interstitial fibrosis and tubular atrophy at the time of biopsy.</p><p><strong>Conclusion: </strong>Arteriolar wall thickening in IgAN are associated with reduced eGFR and global glomerulosclerosis. Moreover, reduced eGFR and global glomerulosclerosis are correlated with the progression to end-stage renal disease. Although the direct correlation between vascular lesions and end-stage renal disease is not entirely clear, a marginally significant association (log-rank test, p = 0.06) was observed with arterial wall thickening. This study suggests the potential importance of vascular lesions in the prognosis of IgAN, encouraging further investigation using larger cohort studies to establish a clearer association.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484363/pdf/","citationCount":"0","resultStr":"{\"title\":\"Significance of intrarenal vascular lesions in Ig A nephropathy prognosis.\",\"authors\":\"Hyeon Tae Yang, Tae In Park, Yong-Jin Kim, Mee-Seon Kim, Sun-Hee Park, Jeong-Hoon Lim, Yoo Na Kang, DongJa Kim, Man-Hoon Han\",\"doi\":\"10.1186/s12882-024-03803-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Immunoglobulin A nephropathy (IgAN) is the predominant primary glomerulonephritis globally and remains a subject of active research with a focus on understanding its course and prognosis. Although vascular lesions are associated with IgAN, the current histopathological grading systems do not consider intrarenal vascular lesions when predicting patient prognosis. Therefore, this retrospective study conducted at Kyungpook National University Hospital between October 2016 and December 2021, aimed to elucidate the significance of intrarenal vascular lesions in IgAN by comparing the clinical data of patients with and without such lesions.</p><p><strong>Methods: </strong>Data of patients with biopsy-confirmed primary IgAN between October 2016 and June 2021 at Kyungpook National University Hospital (Daegu, South Korea) were collected, and their medical records were reviewed. All slides from these 138 cases were independently pathologically reviewed by two nephropathologists (Y. J. K. and M. S. K.) using light microscope. The vascular lesions included in this study were fibrous intimal thickening, arteriolar wall thickening, and arteriolar hyalinosis. All cases were reviewed according to the Oxford Classification of IgA Nephropathy (2016) and Haas classification.</p><p><strong>Results: </strong>Of the 138 patients, 88 exhibited at least one intrarenal vascular lesion. Patients with arteriolar wall thickening demonstrated a reduced estimated glomerular filtration rate (eGFR), elevated serum creatinine level and urine protein-to-creatinine ratio, an increased proportion of global glomerulosclerosis, and a higher histologic grade of interstitial fibrosis and tubular atrophy at the time of biopsy.</p><p><strong>Conclusion: </strong>Arteriolar wall thickening in IgAN are associated with reduced eGFR and global glomerulosclerosis. Moreover, reduced eGFR and global glomerulosclerosis are correlated with the progression to end-stage renal disease. 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引用次数: 0
摘要
背景:免疫球蛋白 A 肾病(IgAN)是全球最主要的原发性肾小球肾炎,其病程和预后一直是积极研究的重点。虽然血管病变与 IgAN 相关,但目前的组织病理学分级系统在预测患者预后时并未考虑肾内血管病变。因此,这项于2016年10月至2021年12月在庆北国立大学医院进行的回顾性研究旨在通过比较有无肾内血管病变患者的临床数据,阐明肾内血管病变在IgAN中的重要性:收集了2016年10月至2021年6月期间在庆北国立大学医院(韩国大邱)经活检确诊的原发性IgAN患者的数据,并审查了他们的病历。两名肾病病理学家(Y. J. K. 和 M. S. K.)使用光学显微镜对这 138 例病例的所有切片进行了独立病理审查。本研究中的血管病变包括纤维内膜增厚、动脉壁增厚和动脉透明变性。所有病例均根据 IgA 肾病牛津分类法(2016 年)和哈斯分类法进行了复查:结果:在138名患者中,88人至少有一处肾内血管病变。动脉壁增厚患者的估计肾小球滤过率(eGFR)降低,血清肌酐水平和尿蛋白肌酐比值升高,肾小球全面硬化的比例增加,活检时组织学上间质纤维化和肾小管萎缩的等级升高:结论:IgAN患者的动脉管壁增厚与eGFR降低和肾小球全面硬化有关。结论:IgAN 患者的动脉壁增厚与 eGFR 降低和肾小球全面硬化有关,而且 eGFR 降低和肾小球全面硬化与终末期肾病的进展相关。虽然血管病变与终末期肾病之间的直接相关性尚不完全清楚,但观察到动脉壁增厚与血管病变之间有轻微的相关性(对数秩检验,p = 0.06)。这项研究表明,血管病变在 IgAN 的预后中具有潜在的重要性,因此需要利用更大规模的队列研究来进一步调查,以建立更明确的关联。
Significance of intrarenal vascular lesions in Ig A nephropathy prognosis.
Background: Immunoglobulin A nephropathy (IgAN) is the predominant primary glomerulonephritis globally and remains a subject of active research with a focus on understanding its course and prognosis. Although vascular lesions are associated with IgAN, the current histopathological grading systems do not consider intrarenal vascular lesions when predicting patient prognosis. Therefore, this retrospective study conducted at Kyungpook National University Hospital between October 2016 and December 2021, aimed to elucidate the significance of intrarenal vascular lesions in IgAN by comparing the clinical data of patients with and without such lesions.
Methods: Data of patients with biopsy-confirmed primary IgAN between October 2016 and June 2021 at Kyungpook National University Hospital (Daegu, South Korea) were collected, and their medical records were reviewed. All slides from these 138 cases were independently pathologically reviewed by two nephropathologists (Y. J. K. and M. S. K.) using light microscope. The vascular lesions included in this study were fibrous intimal thickening, arteriolar wall thickening, and arteriolar hyalinosis. All cases were reviewed according to the Oxford Classification of IgA Nephropathy (2016) and Haas classification.
Results: Of the 138 patients, 88 exhibited at least one intrarenal vascular lesion. Patients with arteriolar wall thickening demonstrated a reduced estimated glomerular filtration rate (eGFR), elevated serum creatinine level and urine protein-to-creatinine ratio, an increased proportion of global glomerulosclerosis, and a higher histologic grade of interstitial fibrosis and tubular atrophy at the time of biopsy.
Conclusion: Arteriolar wall thickening in IgAN are associated with reduced eGFR and global glomerulosclerosis. Moreover, reduced eGFR and global glomerulosclerosis are correlated with the progression to end-stage renal disease. Although the direct correlation between vascular lesions and end-stage renal disease is not entirely clear, a marginally significant association (log-rank test, p = 0.06) was observed with arterial wall thickening. This study suggests the potential importance of vascular lesions in the prognosis of IgAN, encouraging further investigation using larger cohort studies to establish a clearer association.
期刊介绍:
BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.