Nephrology Dialysis Transplantation, Vol 12, Issue 12 2569-2575, Copyright © 1997 by Oxford University Press
L Firmat, S Briancon, D Hestin, B Aymard, E Renoult, T Huu, M Kessler and L des Nephrologues de l'Est
Background: As yet, no clinical or morphological
prognostic classification of IgA nephropathy (IgAN) has been generally
accepted. The objective our study was to quantify the risk of developing
end-stage renal failure (ESRF) in IgAN. Methods: We
report a prospective longitudinal study of 210 patients with IgAN confirmed
by biopsy between 1987 and 1991. Thirty-two (15.2%) patients were lost to
follow-up. Mean follow-up after renal biopsy was 5.6 (SD=2.6) years. The
variables included age, gender, illnesses prior to discovery of IgAN,
clinical features at IgAN discovery, 24-h proteinuria, serum creatinine,
IgA level, and antihypertensive drugs taken at the time of renal biopsy.
Sixty-six renal biopsies were classified by light-microscopy according to
Lee's morphological classification. The end-point was ESRF. Survival was
analysed by a backward and forward stepwise procedure using the Cox model.
The most accurate determination of relative risk was obtained by assessing
collinearity of the variables. Results: Thirty-three
patients (15.7%) (31 men) developed ESRF. The five univariately significant
variables: gender, gross haematuria, 24-h proteinuria (24-P), serum
creatinine (SC), and antihypertensive treatment, were candidates for
multivariate analysis. The final model used SC (⩽100, 100-150
>150 &mgr;mol/l), 24-P (<1, ⩾1 g/day) and gender
(female vs male) as independent variables (relative
risk and 95% confidence interval were 3.5 (2.1, 5.9 for SC; 5.1 (1.9, 13.6)
for 24-P; and 3.5 (0.9, 15) for gender). These estimates were used to
construct a prognostic classification of ESRF for men with IgAN: stage 1
(SC⩽150 &mgr;mol/l and 24-P<1 g/day), stage 2
((SC>150 &mgr;mol/l and 24-P<1 g/day) or (SC⩽150
&mgr;mol/l and 24-P⩾1 g/day)); stage 3 (SC>150
&mgr;mol/l and 24-P⩾1 g/day). The ESRF-free survival was
estimated with Kaplan-Meier analysis. It was 98.5% for stage 1, 86.6% for
stage 2, 21.3% for stage 3 (P<0.001), 6 years after histological
diagnosis. The validity of Lee's prognostic classification was confirmed
using an independent sample. Conclusions: These
classifications identify groups at high risk of ESRF. Therapeutic studies
should focus on these groups. Key words: end-stage
renal failure; IgA nephropathy; prognostic classification
ORIGINAL ARTICLES
IgA nephropathy: prognostic classification of end-stage renal failure
Service de Nephrologie, Hopitaux de Brabois, F-54500 Vandoeuvre-les-Nancy, France; Corresponding author
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