Precil Diego Miranda de Menezes Neves , Rafael A. Souza, Fábio M. Torres, Fábio A. Reis, Rafaela B. Pinheiro, Cristiane B. Dias, Luis Yu, Viktoria Woronik, Luzia S. Furukawa, Lívia B. Cavalcante, Stanley de Almeida Araújo,David Campos Wanderley, Denise M. Malheiros, Lectícia B. Jorge
Abstract
IgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide. According to the Oxford Classification, changes in the kidney vascular compartment are not related with worse outcomes. This paper aims to assess the impact of thrombotic microangiopathy (TMA) in the outcomes of Brazilian patients with IgAN.
Introduction
IgA nephropathy (IgAN) is a highly prevalent condition worldwide and ranks as the most common primary glomerulopathy in some countries [1–3]. Given the high prevalence of the disease and the fact that about 30% of the patients with IgAN progress to chronic kidney disease (CKD) requiring kidney replacement therapy (KRT) [1,4], it is imperative to identify clinical and histology markers associated with worse renal outcomes.
Materials and methods
Study design and population
This retrospective single-center study included patients diagnosed with IgA nephropathy based on kidney biopsy findings from 2000 to 2018. Patients with IgAN secondary to systemic conditions (Henoch-Schönlein purpura, liver disease, autoimmune disease, HIV infection) and individuals with insufficient follow-up or outcome data were excluded, along with patients with fewer than eight glomeruli for analysis via the Oxford Classification.
Discussion
Some clinical findings associated with worse outcomes in individuals with IgAN–male sex, older age, persistent microscopic hematuria, hypertension, proteinuria, and creatinine levels on kidney biopsy [21–24]–have been described as a factor in the progression to CKD-KRT within five years seen in approximately 30% of the individuals with the condition [4,22,25]. In light of this fact and the variety of histologic findings to consider, the need to standardize the analysis of kidney biopsy of IgAN patients and the search for histology-related prognostic factors led to the creation of histologic classifications [6–8,26], with the Oxford Classification standing as the most widely accepted among pathologists and nephrologists.
Citation:Neves PDMdM, Souza RA, Torres FM, Reis FA, Pinheiro RB, Dias CB, et al. (2020) Evidences of histologic thrombotic microangiopathy and the impact in renal outcomes of patients with IgA nephropathy. PLoS ONE 15(11): e0233199. https://doi.org/10.1371/journal.pone.0233199
Editor:Giuseppe Remuzzi, Istituto Di RicercheFarmacologiche Mario Negri, ITALY.
Received:April 28, 2020; Accepted: September 30, 2020; Published: November 4, 2020.
Copyright:© 2020 Neves et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability:All relevant data are within the manuscript.
Funding:The authors received no specific funding for this work.
Competing interests:The authors have declared that no competing interests exist.
