Vasculitic IgA nephropathy: prognosis and outcome.

BACKGROUND: A vasculitic glomerulonephritis is seen in both IgA nephropathy and Henoch-Schonlein purpura. No study has examined prognostic factors in vasculitic IgA nephropathy. METHODS: All patients with vasculitic IgA presenting to our centre between January 1996 and May 2003 were retrospectively reviewed by analysis of clinical and pathological features at presentation and during follow-up. RESULTS: Of 363 patients with IgA nephropathy, 67 patients had vasculitic IgA nephropathy (33 Henoch-Schönlein purpura; 34 IgA). Median length of follow-up was 32.38 months (range 0-90). Median glomerular filtration rate at presentation was 45.56 ml/min (range 4-110), arterial blood pressure 104.67 mm Hg and proteinuria 1.19 g/24 h (range 0-14.8) falling during follow-up to 0.11 g (range 0-3.1). Median chronic damage at presentation in the biopsy was 10% (range 0-91). The majority (79%) were immunosuppressed with 84% patient survival and 85% renal survival at 60 months. Three factors significantly affected renal outcome: renal function; blood pressure at presentation and the amount of chronic damage in the biopsy. The effect of immunosuppression on outcome was difficult to comment on as treated and untreated groups were not comparable. CONCLUSIONS: Presenting renal function, blood pressure and chronic damage in the biopsy are important prognostic factors in vasculitic IgA nephropathy. Immunosuppression is advocated in some patients.