In-depth ReviewNatural history of idiopathic IgA nephropathy: Role of clinical and histological prognostic factors*,**
Section snippets
Actuarial renal survival in adults
Eighteen studies (Table 1) performed in different geographic areas on large relatively nonselected cohorts of adult patients in which the actuarial renal survival rate at 10 years was calculated by using life-time survivorship analysis were selected.In Table 1, together with the results of this analysis, some relevant demographic data and clinical features at the time of presentation are listed. This included prevalence of renal insufficiency, arterial hypertension, severe proteinuria, and
Actuarial renal survival in children
Definitely less numerous are the studies of outcome for sufficiently large cohorts of pediatric patients, and their results do not clearly establish whether the renal survival rate of children is better than that of adults.
To our knowledge, only three studies have compared the outcome of cohorts of adult and pediatric patients who underwent biopsy by the same investigators.17, 21, 24 Kusumoto et al17 in Japan reported a 10-year actuarial renal survival of approximately 80% (Table 1) in a cohort
Clinical, histological, and genetic prognostic factors in adults and children
Among the numerous studies of clinical and histological predictors of an unfavorable outcome in adult patients with IgA nephropathy, we selected, according to the criteria previously mentioned, 25 studies in which a univariate analysis of the various risk factors, each independently considered, was performed, usually comparing renal survival rates calculated according to the method of Kaplan and Meier.4, 5, 6, 9, 10, 12, 16, 18, 19, 21, 22, 23, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 In only 16
Conclusive comments
The data on the predictive value of the various clinical, histological, and genetic factors for the progression of IgA nephropathy discussed in the previous sections deserve some commentary.
The four strongest predictors of an unfavorable outcome listed in Table 2 are nonspecific markers of severity, valid for all glomerular diseases, as already stressed by the author.2, 58
The presence of arterial hypertension at presentation, another clinical marker of severity, loses part of its statistical
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Supported in part by European Union Concerted Action Grant no. BMH4-CT98-3631 (DG12-SSMI) and by the Associazione per la Ricerca in Nefrologia.
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Address reprint requests to Giuseppe D’Amico, MD, Department of Nephrology and Urology, San Carlo Borromeo Hospital, Via Pio II, 3, 20153 Milano, Italy. E-mail: [email protected]