Tubular lesions determine prognosis of IgA nephropathy

To assess the prognostic value of histological classification for renal out come, we did a multivariate analysis of 194 patients with immunoglobulin A (IgA) nephropathy between 1985 and 1995, We also evaluated semiquantitative scales of tubular lesions and vessel lesions, At the time of the biopsy, 6 5 patients (33.5%) had chronic renal failure. At the end of the follow-up, 33 patients (17%) required hemodialysis. The mean age of the patients was 3 7.8 +/- 18.9 years with predominance of men (sex-ratio: 3.12), Patients wer e followed-up for a mean of 43.2 +/- 37.2 months. Univariate analysis showe d that hypertension (P < 10(-4)), nephrotic syndrome (P = 0.01), and cresce nts (P = 0.02) were significant in predicting renal failure, unlike subendo thelial topography of IgA deposits (P = 0.05) and proteinuria (P = 0.05), H ematuria was a protective factor (P = 0.03), Multivariate analysis showed t hat tubular grade 2 (relative risk [RR], 5.5) and tubular grade 3 (RR = 28. 8) were the best factors to predict chronic renal failure. The histological classification of Haas was significant in the univariate analysis, but not in the multivariate analysis. Tubular grading predicted renal outcome bett er than did the other histological parameters. (C) 2000 by the National Kid ney Foundation, Inc.