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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
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IgA nephropathy clinicopathologic study following the Oxford classification: Progression peculiarities and gender-related differences

1
Institute of Pathological Anatomy and Forensic Medicine, Tartu University, Tartu, Estonia
2
Vilnius University and National Centre of Pathology, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
3
Department of Internal Medicine, Tartu University and Tartu University Hospital, Tartu, Estonia
4
West-Tallinn Central Hospital, Tallinn, Estonia
5
North Estonia Medical Centre, Tallinn, Estonia
*
Author to whom correspondence should be addressed.
Medicina 2016, 52(6), 340-348; https://doi.org/10.1016/j.medici.2016.11.003
Received: 30 October 2015 / Revised: 5 October 2016 / Accepted: 10 November 2016 / Published: 22 November 2016
Background and aim: Immunoglobulin A nephropathy (IgAN) is the most frequent glomerular disease worldwide and one of the main causes of chronic kidney disease. We aimed to investigate clinicopathological correlations in IgAN patients by gender.
Materials and methods: The study was based on a retrospective analysis of renal biopsy data and clinical manifestations of the disease. Consecutive 73 biopsy-proven IgAN cases of male (62%) and female (38%) patients were investigated. Renal biopsies were reviewed using the new Oxford classification assessing the MEST (mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis/adhesion, tubular atrophy/interstitial fibrosis) score. The most powerful IgAN prognostic risk factors, morphological (segmental glomerulosclerosis and tubular atrophy/interstitial fibrosis) as well as clinical (proteinuria and hypertension) were taken into account in the correlation analysis. The mean rate of renal function decline was expressed as a slope of eGFR during the follow-up (FU) dividing delta GFR with the FU years.
Results: The mean age of the patients was 33.7 years (range, 16–76). Follow-up data were available for 64 patients with the mean follow-up of 4.1 years. The mean proteinuria at biopsy was 0.79 g/24 h. The mean arterial pressure (MAP) was 94.5 ± 16.7 mmHg and 7% of the patients were hypertensive. The initial mean estimated glomerular filtration rate (eGFR) was 94.9 ± 30.7 mL/min, at the end of the follow-up it was 86.2 ± 27.1 mL/min. The mean rate of renal function decline was −3.4 ± 11.9 mL/min/1.73 m2 per year in males (P < 0.05) and −0.7 ± 5.3 mL/min/1.73 m2 per year in females. The Spearman correlation analysis confirmed a higher MEST score in the whole cohort and in males correlated with disease progression. In patients with proteinuria below 1.0 g/24 h, disease progression was faster in males.
Conclusions: According to the correlation analysis of the main prognostic risk factors, affecting the progression of IgAN, we can conclude that IgA nephropathy in males progresses more rapidly compared to females.
Keywords: Gender-related differences; Glomerular filtration rate; IgA nephropathy; Oxford classification of IgA nephropathy; Renal biopsy Gender-related differences; Glomerular filtration rate; IgA nephropathy; Oxford classification of IgA nephropathy; Renal biopsy
MDPI and ACS Style

Riispere, Ž.; Laurinavičius, A.; Kuudeberg, A.; Seppet, E.; Sepp, K.; Ilmoja, M.; Luman, M.; Kõlvald, K.; Auerbach, A.; Ots-Rosenberg, M. IgA nephropathy clinicopathologic study following the Oxford classification: Progression peculiarities and gender-related differences. Medicina 2016, 52, 340-348.

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