Prognosis

The Foundation for IgA Nephropathy

Prognosis

Prognosis is very vague with IgAN at the best of times. This is why, in the case of chronic IgAN, you are unlikely to get much more from your doctor than maybe kidney failure in 10 to 25 years, maybe never (that is, the person will reach old age and die before the kidneys have enough time to fail completely). However, there are a few factors which seem to indicate that the disease is more likely to progress:

It's important to note that none of this is hard fact, and it doesn't apply to rapidly-progressive cases with extensive crescents on the biopsy. Even with all the indicators for a poor prognosis, it might still take years or even decades until the person reaches end-stage and needs dialysis or transplant.

Hypertension. This is the medical term for high blood pressure. The generally-accepted target blood pressure for IgAN patients is about 125/75. For some patients, this may be very hard to achieve without multiple medications and a low-sodium diet. Even if the goal cannot be met, lower is better. See the "Hypertension Notebook" section for more information about high blood pressure.

Elevated serum creatinine. If serum creatinine is already elevated at the time of diagnosis, this means the patient has probably lost close to 50% of his or her kidney function, and will continue to slowly lose more. Somewhere between 200 and 300 umol/liter (approximately 2.2 to 3.5 mg/dl in the U.S.), there is a point of no return after which it is likely that end-stage will be reached eventually.

Gross proteinuria. Persistent protein in urine of more than 0.4 grams per day. The theory behind this is that protein may actually itself cause further damage to the nephrons (specifically, the tubules and the interstitium around them).

High cholesterol. Heavy proteinuria can lead to low levels of protein in the blood, which in turn causes higher cholesterol levels.

Glomerulosclerosis. The amount of glomerulosclerosis (scarring of the glomeruli) at the time of biopsy may be an indicator of prognosis. The pathology report from the biopsy will usually express glomerulosclerosis as a percentage of the glomeruli which are scarred. If the average sclerosis per glomerulus is less than 10%, there might be a chance it won't progress very fast or maybe at all with the right treatment (especially the right blood pressure medications).

IgG. Urinary excretion of IgG immune complexes may be an indicator of less favourable prognosis.

Webmaster's example

It took the author of this website 25 years to reach the stage where dialysis was needed, after the first discovery of blood in the urine during a routine medical examination. Some people only find out they have renal failure when it is already advanced, some have rapidly-progressing IgAN and may need dialysis within a few short years, and some may progress faster than others. Some many never progress to end-stage renal failure. So, the best that we can say is that "it depends". Your nephrologist should be able to give you some kind of prognostication. However, if you have the usual, slowly-progressive kind of IgAN and it is still in the early to moderate stages, any prediction of time-to-dialysis is likely to be in the "maybe never, maybe within 10 to 25 years" variety. That's often the best anyone can do, until there are a number of years of follow-up to go by. During the 25 years it took the author to reach dialysis, it wasn't really apparent that it would progress to that until the last 5 years or so, and a more firm prediction wasn't possible until the final couple of years.

Webmaster

This page last updated: