Twenty percent of patients initiating Medicare-supported
end-stage renal disease (
ESRD)
therapy in the United States have chronic
glomerulonephritis-induced
ESRD.
IgA nephropathy (IgAN) and focal and
segmental glomerulosclerosis (FSGS) likely account for many of these incident dialysis cases, although patients presenting with advanced
renal insufficiency may not receive renal biopsies. To determine whether HLA phenotype associations existed in the subset of IgAN and FSGS patients who develop
ESRD, we analyzed HLA frequencies by race in patients with these etiologies of
ESRD entered in the South Eastern Organ Procurement Foundation (SEOPF) database. Serologically determined HLA frequencies from 605 renal transplant recipients with
ESRD due to FSGS and 196 renal transplant recipients with
ESRD due to IgAN were compared with those of 4,506 race-matched cadaveric kidney-donor controls. Race-specific odds ratios (
ORs) were calculated and fitted into a log-linear model to determine associations between the HLA system and
ESRD due to IgAN and FSGS. Values reported were considered significant (P < 0.05) after Bonferroni correction for multiple comparisons.
HLA-B27 and
HLA-DR1 frequencies were increased and
HLA-DR2 frequency was decreased in African-American and white IgAN-induced
ESRD cases compared with race-matched controls (race-combined OR of 2.10, 1.89, and 0.57, respectively; all P < or = 0.004). HLA frequency differences were not observed in FSGS-induced
ESRD patients compared with controls. The results of this study indicate that
HLA-B27 and
HLA-DR1 are positively associated and
HLA-DR2 is negatively associated with IgAN-induced
ESRD in patients of both races.(ABSTRACT TRUNCATED AT 250 WORDS)