Pathologic and Clinical Analysis of IgA Nephropathy Associated with Acute Renal Failure

Objective:To investigate the pathologic and clinical characteristics of IgA nephropathy associated with acute renal failure(ARF).Methods:We performed a retrospective analysis of 20 patients who had biopsy-proven IgAN and presented an ARF in the period of 1992 to 2006.According to different pathology,we selected different therapeutic treatments and undertook follow-up visit.Results:Twenty patients of IgA nephropathy with ARF were included and the percentage of occurrence is 3.8%(20/527).Among the 20 patients,there were 4 acute nephritic syndrome,5 acute nephritic syndrome associated with nephrotic syndrome,8 focusing on puffiness and oliguria,3 focusing on malignant hypertension.About pathologic change,there were 5 cases of mesangial proliferative nephritis,8 cases of crescentic nephritis,3 cases of proliferative sclerosing nephritis associated with crescentic nephritis,and 4 cases of light mesangial proliferative nephritis associated with acute interstitial nephritis.Renal function returned to normal in 14 patients;partial remission was observed in 4 patients;kidney transplantation was performed after invalidity dialysis treatment in 2 patients.Conclusion:The incidence rate of IgA nephropathy associated to acute renal failure was 3.8%,much higher than that reported by the literature.Clinical manifestations were diversive and pathology showed many kinds of pathologic types.If pathology was light,prognosis was good.Moreover,the prognosis of crescentic nephritis was also fine if diagnosed and treated in time.Most of patients'renal function could return to normal.So it was important to guide therapy and judge prognosis in IgA nephropathy that renal biopsy was in earlier stage and in time.It was suggested that accepting renal biopsy in earlier time,identifying pathology and active treatment could improve prognosis.