PLoS ONE (Jan 2020)

Evidences of histologic thrombotic microangiopathy and the impact in renal outcomes of patients with IgA nephropathy.

  • 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

DOI
https://doi.org/10.1371/journal.pone.0233199
Journal volume & issue
Vol. 15, no. 11
p. e0233199

Abstract

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IntroductionIgA 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.Materials and methodsAnalysis of clinical data and kidney biopsy findings from patients with IgAN to assess the impact of TMA on renal outcomes.ResultsThe majority of the 118 patients included were females (54.3%); mean age of 33 years (25;43); hypertension and hematuria were observed in 67.8% and 89.8%, respectively. Median creatinine: 1.45mg/dL; eGFR: 48.8ml/min/1.73m2; 24-hour proteinuria: 2.01g; low serum C3: 12.5%. Regarding to Oxford Classification: M1: 76.3%; E1: 35.6%; S1: 70.3%; T1/T2: 38.3%; C1/C2: 28.8%. Average follow-up: 65 months. Histologic evidence of TMA were detected in 21 (17.8%) patients and those ones presented more frequently hypertension (100% vs. 61%, p ConclusionsIn this study patients with TMA had worse clinical manifestations and outcomes. In terms of histologic evidence, E1 distinguished patients with TMA from other patients. Further studies are necessary to analyze the impact of vascular lesions on IgAN prognosis.