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Korean J Med > Volume 88(4); 2015 > Article
The Korean Journal of Medicine 2015;88(4): 397-405.
IgA 신증 환자의 병리소견과 임상경과
이준영1, 양재원1, 김재석1, 김영섭1, 박현철1, 채문희1, 최승옥1, 엄민섭2, 한병근1
1연세대학교 원주의과대학 내과학교실
2연세대학교 원주의과대학 병리학교실
Pathology and Renal Outcome of IgA Nephropathy
Jun Young Lee1, Jae Won Yang1, Jae Seok Kim1, Young Sub Kim1, Hyeoncheol Park1, Moon Hee Chae1, Seung Ok Choi1, Minseob Eom2, Byoung Geun Han1
1Departments of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
2Departments of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
Corresponding Author: Byoung Geun Han ,Tel: +82-33-741-0509, Fax: +82-33-731-5884, Email: neptune@yonsei.ac.kr
Received: August 6, 2014;   Revised: August 20, 2014;   Accepted: October 16, 2014.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Oxford classification of immunoglobulin A nephropathy (IgAN) is a pathology-based prognostic classification system. However, further study is needed to determine its validity. We studied the relationships between the Oxford classification and established prognostic factors and renal survival. We also examined associations between electron microscopy findings and these parameters.
We reviewed and reclassified 213 patients who were diagnosed with IgAN from 1997 to 2007 using the Oxford and World Health Organization (WHO) classification systems. The patients were also categorized by a pathologist using electron microscopy findings, including foot process fusion, glomerular basement membrane thickness, and electron-dense deposits. We examined the correlations between light and electron microscopy data and known prognostic factors (e.g., age, sex, proteinuria, serum creatinine, estimated glomerular filtration rate [eGFR], and blood pressure). The same procedure was applied to renal survival.
Patient age increased with the grades of segmental sclerosis (S) and tubular atrophy/interstitial fibrosis (T) (p < 0.05). eGFR decreased significantly with increasing mesangial hypercellularity (M) (p = 0.0034), S (p = 0.0003), endocapillary hypercellularity (E) (p = 0.0411), and T (p < 0.0001). MSET differed significantly by sex (p < 0.0001). The 24-h urine protein/creatinine ratio increased significantly with the degrees of S (p = 0.036), E (p = 0.0155), and T (p = 0.015). The serum creatinine level was significantly higher in patients with T2 than T1 or T0 (p < 0.0001). At the time of biopsy, the degree of tubular atrophy/interstitial fibrosis affected the doubling of serum creatinine or end-stage renal disease. However, the electron microscopy findings did not predict the renal outcome.
Our study suggests that tubular atrophy/interstitial fibrosis is significantly associated with proteinuria and renal progression in IgAN.
Keywords: IgA nephropathy; Prognosis; Oxford classification; Electron microscopy
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