MP185CLINICAL-PATHOLOGICAL CORRELATIONS AND PROGNOSTIC FACTORS IN A SICILIAN COHORT OF IGAN PATIENTS: A MULTICENTER RETROSPECTIVE ANALYSIS

Abstract

INTRODUCTION AND AIMS: IgAN is the most common form of primary glomerulonephritis and one of the leading causes of end‐stage kidney failure. Predominant deposition of IgA‐containing immune complexes in the glomerular mesangium is a necessary criterion for diagnosis. Long‐term outcome is related to different factors including clinical, genetic as well as morphological ones. Therapy is mainly based on the use of RAAS inhibitors, steroids and immunosuppressants but different approaches are used depending on personal experience or generic national guidelines. METHODS: We performed a multicenter retrospective analysis of renal biopsy data and clinical manifestations in 99 biopsy‐proven IgAN cases of male (68,7%) and female (31,3%) patients from three Sicilian nephrological centres. Patients were treated in most cases with steroids. Renal biopsies were reviewed using the new Oxford classification assessing the MEST (mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis/adhesion, tubular atrophy/interstitial fibrosis) score. RESULTS: Patients were 46 ± 15years old (range, 18‐82) and had been followed‐up for 45.70 ± 39.04 months. At the Wilcoxon test for paired samples, proteinuria underwent a significant reduction from baseline [1.58 (0.70 ‐ 2.80) g/24h] to the end of follow‐up [0.80 (0.41 ‐ 1.12) g/24h] (P < 0.0001). Conversely, serum creatinine slightly increased from 1.15 (0.90 ‐ 1.62) mg/dl at diagnosis to 1.20 (1.00 ‐ 1.82) mg/dl at follow‐up (P = 0.0433). Proteinuria at follow‐up was significantly and positively correlated with M score (r=0.289; P=0.05), T score (r=0.435; P=0.0032), proteinuria at diagnosis (r=0.436; P=0.0017), systolic blood pressure (r=0.413; P=0.0151) and diastolic blood pressure at diagnosis (r=0.328; P=0.05). Serum creatinine at follow‐up was positively correlated with T score (r=0.629; P<0.0001), baseline serum creatinine (r=0.681; P<0.0001), proteinuria at diagnosis (r=0.427; P=0.0001), systolic blood pressure (r=0.486; P<0.0001) and diastolic blood pressure at diagnosis (r=0.365; P=0.0030). CONCLUSIONS: Our study shows that IgAN in Sicilian patients treated with steroids has a favourable outcome comparing with literature data, resulting in a nonprogressive disease in a follow‐up period of almost four years. The correlations we found between proteinuria, serum creatinine and some parameters of the MEST score suggest the need to design large randomized studies to establish the best therapeutic approach according to different renal presentation and morphological damage.