ABSTRACT Background. The clinical course of IgA nephropathy (IgAN) is highly variable. In order to verify the necessity of early medical intervention in IgAN patients, the present study investigated the clinical impact of the duration between disease onset and first medical intervention on renal prognosis. Methods. We enrolled 57 patients diagnosed with IgAN on the basis of biopsy performed at our hospital. The medical records of these patients were traceable to the last 10 years, during which they had not undergone dialysis or treatment at any other hospital. On the basis of histological assessment of prognosis, these patients were classified according to the Japanese guidelines into the following groups: groups I, good prognosis; group II, relatively good prognosis; group III, relatively poor prognosis; and group IV, poor prognosis. We investigated the correlation between the duration of disease onset and the first consultation with a nephrologist and the rate of increase in serum creatinine over a 10 year period. In addition to the abovementioned patients, 6 patients with IgAN who underwent dialysis within the 10 years were separately evaluated. These patients came under the poor prognosis category; i.e., they belonged to group IV. Results. The duration between disease onset and medical consultation was significantly longer in younger patients or in those with asymptomatic proteinuria at onset when compared to that in older patients or in those with other urinary abnormalities. There was a significant correla tion between this duration and renal prognosis, particularly in group III patients. Although the duration between onset and consultation was not correlated to the serum creatinine level at the time of first medical intervention, urinary protein level among group IV patients at the time of first consultation was significantly higher in patients with dialysis than that in those without dialysis. Conclusions. Early medical intervention may lead to a better renal prognosis, particularly in group III patients, who form a major portion of the IgAN population. It therefore appears that early diagnostic screening and subsequent intervention are important for a good prognosis in IgAN patients.
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nullOkazaki,, K. , Suzuki, Y. , Kobayashi, T. , Kodama, F. , Horikoshi, S. and Tomino, Y. (2011) Influence of the period between onset of IgA nephropathy and medical intervention on renal prognosis. Health, 3, 518-523. doi: 10.4236/health.2011.38086.
 Japanese Society for Dialysis Therapy (2008) An overview of regular dialysis treatment in Japan. Japanese So- ciety for Dialysis Therapy, Tokyo.
Shinzato, T., Narita, S., Akiba, T., et al. (1999) Report of the annual statistical survey of the Japanese Society for Dialysis Therapy in 1996. Kidney International, 55, 700- 712. doi:10.1046/j.1523-1755.1999.00297.x
Weiner, D.E., Tighiouart, H., Amin, M.G., et al. (2004) Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: A pooled analysis of community-based studies. Journal of the American Society of Nephrology, 15, 1307-1315.
Jafar, T.H., Stark, P.C., Schmid, C.H., et al. (2003) Progression of chronic kidney disease: The role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: A patient-level meta-analysis. Annals of Internal Medicine, 139, 244-252.
Koyama, A., Igarashi, M. and Kobayashi, M. (1997) Natural history and risk factors for immunoglobulin A nephropathy in Japan. Research group on progressive renal diseases. American Journal of Kidney Diseases, 29, 526-532. doi:10.1016/S0272-6386(97)90333-4
Goto, M., Wakai, K., Kawamura, T., et al. (2009) A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective chhort study. Nephrology, Dialysis Transplantation, 24, 3068-3074.
Alamartine, E., Sabatier, J.C., Guerin, C., Berliet, J.M. and Berthoux, F. (1991) Prognostic factors in mesangial IgA glomerulonephritis: An extensive study with univariate and multivariate analyses. American Journal of Kidney Diseases, 18, 12-19.
D'Amico, G. (2000) Natural history of idiopathic IgA nephropathy: Role of clinical and histological prognostic factors. American Journal of Kidney Diseases, 36, 227- 237. doi:10.1053/ajkd.2000.8966
Chauveau, D. and Droz, D. (1993) Follow-up evaluation of the first patients with IgA nephropathy described at Necker Hospital. Contribution to Nephrology, 104, 1-5.
Tomino, Y. and Sakai, H. (2003) Clinical guidelines for immunoglobulin A (IgA) nephropathy in Japan, second version. Clinical and Experimental Nephrology, 7, 93-97.
Woolhandler, S., Pels, R.J., Bor, D.H., Himmelstein, D.U. and Lawrence, R.S. (1989) Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders. I. Hematuria and proteinuria. The Jouranl of the American Medical Association, 262, 1214-1219.
Yamagata, K., Ishida, K., Sairenchi, T., et al. (2007) Risk factors for chronic kidney disease in a community-based population: A 10-year follow-up study. Kidney International, 71, 159-166. doi:10.1038/sj.ki.5002017
Yamagata, K., Takahashi, H., Tomida, C., Yamagata, Y. and Koyama, A. (2002) Prognosis of asymptomatic hematuria and/or proteinuria in men. High prevalence of IgA nephropathy among proteinuric patients found in mass screening. Nephron, 91, 34-42.
Maeda, A., Gohda, T., Funabiki, K., Horikoshi, S., Shirato, I. and Tomino, Y. (2003) Significance of serum IgA levels and serum IgA/C3 ratio in diagnostic analysis of patients with IgA nephropathy. Journal of Clinical Laboratory Analysis, 17, 73-76. doi:10.1002/jcla.10071
Nakayama, K., Ohsawa, I., Maeda-Ohtani, A., et al. (2008) Prediction of diagnosis of immunoglobulin A nephropathy prior to renal biopsy and correlation with urinary sediment findings and prognostic grading. Journal of Clinical Laboratory Analysis, 22, 114-118.
Moldoveanu, Z., Wyatt, R.J., Lee, J.Y., et al. (2007) Patients with IgA nephropathy have increased serum galactose-deficient IgA1 levels. Kidney International, 71, 1148-1154. doi:10.1038/sj.ki.5002185