Which clinical features predictive of outcome in immunoglobulin a nephropathy
Are there clinical features predictive of outcome in immunoglobulin a nephropathy?
Yes. In fact, they have been known to have a stronger predictive value than the histologic ones, particularly because they can be measured serially.
The level of sustained proteinuria over time (usually after 2 years of follow-up) has been shown to be the strongest predictor of progression. Regardless of the level of proteinuria at presentation, achieving a complete (proteinuria <300 mg/day) or partial remission (proteinuria <1000 mg/day) is associated with a significant reduction in the rate of progression of the kidney disease.
Mean arterial pressure over time and level of impairment of kidney function have also been identified as important predictors.
Combining clinical factors with the pathologic variables of the Oxford classification can improve risk stratification and management decisions at the time of presentation. Whether isolated hematuria or recurrent macroscopic hematuria are prognostic indicators is still debated.
It seems likely that recurrent gross hematuria may leave subclinical kidney damage that will eventually result in tubular interstitial scarring and a worse long-term outcome, but currently there is little evidence to support that theory.
