Nephrology Dialysis Transplantation, Vol 12, Issue 9 1963-1967, Copyright © 1997 by Oxford University Press
C Geddes, G Warwick, I Tulloch and J Boulton-Jones
Background. Vascular risk factors in first degree
relatives of patients with insulin dependant diabetes mellitus are known to
increase the risk of that patient developing diabetic nephropathy. We
explored the influence of vascular risk factors in first degree relatives
on patients with stable (serum creatinine <150 &mgr;mol/l for
>5 years) and progressive (serum creatinine >200
&mgr;mol/l, and >150% serum creatinine at presentation, after
minimum follow-up at 2 years) IgA nephropathy (IgAN).
Methods. We compared sodium-lithium countertransport
activity (SLC Vmax), plasma lipoprotein(a) and von Willebrand factor (vWf)
concentrations, incidence of vascular disease, and incidence of
hypertension in 37 first degree relatives of 23 patients with stable IgAN
and 33 first degree relatives of 17 patients with progressive IgAN. The two
groups of relatives were comparable with respect to other risk factors:
age, smoking, blood pressure, and plasma glucose, creatinine, cholesterol
and triglyceride concentrations. Results. SLC Vmax was
higher in relatives of stable patients (mean 0.37 mmol/h/l RBC [S.D. 0.18]
vs 0.30 [S.D. 0.09]; P=0.034 two-sample t-test). There
was no difference between the relatives of stable and progressive patients
in plasma lipoprotein(a) concentration (median 11.5 mg/l vs 13.0: P=0.45;
95% C.I. -12 to 3; Mann-Whitney test), plasma vWf concentration (149.4
IU/dl [S.D 55.6] vs. 163.2 IU/dl [S.D. 57.3]; P=0.31 two-sample
t-test), or incidence of hypertension (13/37 [35.1%]
vs 10/33 [30.3%]; &khgr;2=0.185; P=0.667).
Relatives of patients with progressive IgAN had a slightly higher incidence
of vascular disease (10/33 [30.3%] vs 8/37 [21.6%];
&khgr;2=0.688; P=0.407).
Conclusions. Familial vascular risk may increase the
likelihood of progressive renal failure in patients with IgAN but the
influence is likely to be small and unrelated to the factors we measured.
SLC Vmax was significantly higher in relatives of patients with stable
disease which contrasts with data from other studies and is unexplained.
Keywords: familial; IgA nephropathy; lipoprotein(a);
progression; sodium-lithium countertransport; von Willebrand factor
PRELIMINARY REPORTS
The influence of familial factors on the progression of IgA nephropathy
Renal Unit and University Department of Medicine, Glasgow Royal Infirmary, Glasgow, UK; Corresponding author at: Career Registrar in Nephrology, c/o Renal Unit, Stobhill NHS Trust, Balornock Road, Glasgow G21 3UW, UK
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