ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO1032

Long-Term Renal Outcomes In Patients with IgA Vasculitis: A Single-Centre Retrospective Cohort Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Cheung, Chee Kay, University of Leicester, Leicester, United Kingdom
  • Barratt, Jonathan, University of Leicester, Leicester, United Kingdom
  • Al-Jayyousi, Reem, University Hospitals of Leicester, Leicester, United Kingdom
Background

IgA vasculitis (IgAV; Henoch Schönlein purpura) is a small vessel vasculitis that most commonly affects children but also occurs in adults. The long term outcome from IgAV in adult patients with renal involvement is not well described, and treatment protocols are variable.

Methods

We conducted a retrospective study of renal outcomes in patients with IgAV with histologically confirmed renal involvement seen previously within our adult renal service. We searched our local renal and pathology databases for those diagnosed between 1990-2018. Demographic data including age, sex, ethnicity and date of presentation were recorded. Clinical data included serum creatinine and albumin, proteinuria (urine protein:creatinine ratio; UPCR) at presentation and follow up, as well as biopsy findings and treatment.

Results

We identified 59 patients seen within this time period, with median follow up of 64.5 months (interquartile range (IQR) 20.5-114.8). Mean age at diagnosis was 34.5 (±SD 18.4) years. 37 (63%) were male, 45 (88.2%) were Caucasian. 20 (33.9%) had documentation of a prior skin rash (the remainder presented concurrently), occurring a median of 6 months before, with 11 (18.6%) undergoing a skin biopsy. Median eGFR at diagnosis was 84 (42.3-90) ml/min/1.73m2. Median UPCR at presentation was 120 (21.7-481.7) mg/mmol, with 19 (32.2%) having nephrotic-range proteinuria (UPCR > 350 mg/mmol), and 8 (13.6%) with nephrotic syndrome (as previous, plus serum albumin ≤ 30 g/L). 24 (40.7%) patients had evidence of crescents on renal biopsy. 16 (28.1%) were treated with prednisolone alone, and 15 (26.3%) combined with another agent, most commonly mycophenolate mofetil.

At last follow up, 38 (64.4%) had an eGFR >60 ml/min, and 21 (35.6%) below. 8 reached ESRD, at a median of 25 months (2-68.8) months. All had nephrotic range proteinuria (UPCR >350 mg/mmol) at presentation. When compared to those with similar UPCR at presentation, the patients who reached ESRD were younger, had lower eGFR at presentation and had a higher failure rate in achieving remission from their proteinuria.

Conclusion

Overall, in this cohort, patients with IgAV who achieved proteinuria <1g/d had a good outcome. Those who presented with nephrotic range proteinuria with failure to achieve any remission from their proteinuria had a poor outcome in terms of renal survival.

Funding

  • Government Support - Non-U.S.