Histopathological assessment of prognosis of IGA nephropathy.

Kannan Bhaba, V (2012) Histopathological assessment of prognosis of IGA nephropathy. Masters thesis, Kilpauk Medical College, Chennai.


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BACKGROUND : IgA nephropathy is the most common Glomerulonephritis in almost all parts of the world. It is unique among Glomerular diseases is being defined by immunohistochemical findings of Mesangial deposition of IgA. New OXFORD MEST scoring system introduced in 2010 uses four variables that predict the renal outcome accurately. These four variables are 1. Mesangial hypercellularity, 2. Endocapillary proliferation, 3. Segmental sclerosis and 4. Tubular atrophy. AIM OF THE STUDY : To assess the Prognosis of IgA Nephropathy by NEW OXFORD MEST scoring system and to analyze other clinical, biochemical and histological factors in predicting the renal outcome. MATERIALS AND METHODS : Renal case records of Department of Nephrology, Kilpauk Medical College from June 2008 to December 2010 were searched. Case records of Patients with renal biopsy finding of IgA nephropathy were included in this study. NEW OXFORD MEST scoring system was applied and the severity of renal lesion at the time presentation was analyzed. The contribution of the Mean Arterial Pressure, baseline Serum Creatinine, Creatinine Clearance, Proteinuria, serum Uric Acid and serum Triglycerides in predicting the high Total MEST score was analyzed. Clinical, Biochemical and Histopahtological factors other than MEST score in predicting the progression of the disease were also analyzed. RESULTS : A total of 44 patients, 25 patients were males. Mean age group was 31 to 50 yrs of age (52.7%). Mean period of follow up was 17.2 months. Macroscopic hematuria was found in 11 patients (22%). Microscopic hematuria was found in all patients (100%). Systemic hypertension was found in all patients (100%). Nephrotic proteinuria was found in 12 patients (27.3%). Mean urine spot protein creatinine ratio of patients 2.61 gm per gm of creatinine. Mean serum creatinine of the patients was 2.06mg/dl. Mean creatinine clearance of Non Progressors and Progressors was 59.6ml/min and 28.63ml/min respectively. Mean total MEST score of Non Progressors and Progressors was 2.12 and 3.16 respectively. Disease progressed in 19 patients (43.1%) and more in males(58%). Disease progressed more in younger age group(15to30 yrs -63.15%). CONCLUSION : High Total MEST score at the time of presentation is an individual predictor of Disease Outcome. MEST score is neither superior nor inferior in predicting the Renal Outcome when compared to Creatinine Clearance and Nephrotic proteinuria.

Item Type: Thesis (Masters)
Uncontrolled Keywords: IgA nephropathy ; New Oxford MEST score.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 06:35
Last Modified: 11 Jul 2017 06:35
URI: http://repository-tnmgrmu.ac.in/id/eprint/1389

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