THE CLINICAL COURSE OF MESANGIAL IGA ASSOCIATED NEPHROPATHY IN ADULTS

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  • 1 January 1984
    • journal article
    • research article
    • Vol. 53  (210) , 227-250
Abstract
Clinical data in 244 patients with IgA nephropathy and biopsy findings in 519 biopsies (107 patients had at least 2 biopsies) were analyzed. Males predominated (73%) and had more severe disease and a worse prognosis than females. The most frequent symptom was macroscopic hematuria, often with associated loin pain; this was typical only in young males. Hypertension was the major presenting feature in 23% of patients. Urinary erythrocyte counts correlated with the presence of crescents on biopsy (P < 0.0001). Serum IgA levels were elevated in only 21%, while IgM levels were raised in 43% of patients. Patients (217) were followed for at least 1 yr (mean 59.7 mo., range 12-255 mo.). In 82 patients 5-yr follow-up and in 33 patients 10-yr follow-up data were available. Five- and 10-yr survival figures were 91.5 and 87.5%, respectively. Clinical resolution occurred in only 6% of patients but in those who had biopsies following clinical resolution, diffuse mesangial cell proliferation and IgA deposits persisted in all. The rate of clinical deterioration correlated with proteinuria, hypertension, impaired renal function, crescents and sclerosed gomeruli on biopsy. Continuing high urinary erythrocyte counts were the strongest predictor of a progressive course.