The "point of no return" and the rate of progression in the natural history of IgA nephritis.

Based on the observation of 7 patients with chronic IgA nephritis and on a course to end-stage renal failure after several years, D'Amico et al. [1993] reported on a "point of no return" at 2.5 to 3 mg/dl serum creatinine. After exceeding this limit all 7 patients exhibited an irreversible progressive renal failure.
Therefore, 115 patients with IgA nephritis from the "German Glomerulonephritis Therapy Study" were examined in order to look for the existence of such a "point of no return".
Three different courses could be distinguished: a stable chronic course with constantly normal or only minor elevated serum creatinine lasting for years (91 patients), a progressive course with continuously increasing serum creatinine (22 patients), and a rare (only 2 patients) early acute course with a short-term increase of serum creatinine followed by a rapid return to the normal range. After exceeding 3 mg/dl serum creatinine no remissions were observed in the progressive cases. Sixteen patients showed a rapid, continuously progressive course until end-stage renal failure with exactly the same progression as the 7 patients of D'Amico et al. Six patients of the 22 progressors were not observed long enough. The serum creatinine level doubled on average from 3 to 6 mg/dl within 10 months.
Our study confirmed the existence of a "point of no return" at 3 mg/dl (265 micromol/l) during the natural course of chronic IgA nephritis.
AuthorsU Schöll, U Wastl, T Risler, N Braun, B Grabensee, P Heering, P Schollmeyer, I Zäuner, G Stein, R Fünfstück, F Keller
JournalClinical nephrology (Clin Nephrol) Vol. 52 Issue 5 Pg. 285-92 (Nov 1999) ISSN: 0301-0430 [Print] GERMANY
PMID10584991 (Publication Type: Journal Article)
Chemical References
  • Creatinine
  • Adolescent
  • Adult
  • Aged
  • Chronic Disease
  • Creatinine (blood)
  • Disease Progression
  • Female
  • Glomerulonephritis, IGA (blood, complications)
  • Humans
  • Kidney Failure, Chronic (etiology)
  • Male
  • Middle Aged
  • Prognosis

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