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Master Thesis

Étude rétrospective multicentrique de néphropathies à dépôts d’immunoglobuline A associées aux maladies inflammatoires chroniques de l’intestin

Abstract : Background: clinical, pathological characteristics and kidney outcome of patients with immunoglobulin A nephropathy (IgAN) occurring in a context of inflammatory bowel disease (IBD) (IBD-associated IgAN) have been poorly investigated. This study analyzed IBD pattern, kidney features at IgAN onset, therapeutic management and outcome of these patients. Method: we conducted a multicentric retrospective study with centralized histological review to identify patients with IBD-associated IgAN. We compared their main clinical pathological characteristics and renal survival with a cohort of 134 patients with primary IgAN without IBD. Results: Crohn’s disease accounted for 75% of IBD in this IBD-associated IgAN cohort. IgAN occurred in 23/24 cases after the diagnosis of IBD (median 9±6 years). IBD was considered as active at IgAN onset in 23.6%. Hypertension was present in 41.7% of patients. Urinary protein-to-creatinine ratio was higher than 50 mg/mmol in 95.8% of patients (mean 254 mg/mmol). At the time of renal biopsy, 13/24 patients have eGFR higher than 60 ml/min/1.73m2 and only one patient required renal replacement therapy. Centralized review of kidney biopsies, according to Oxford MEST-C classification, found M1, E1, S1, T1+T2 and C1+C2 lesions in 57%, 48%, 76%, 57% and 38% of cases, respectively. Steroids were used in 50% cases, started intravenously in half of the cases. After an average follow-up of 6.8 years, 4 patients (16.7%) reached a poor kidney outcome defined as end-stagerenal-disease (n=3) or a decline > 50% of initial eGFR (n=1). IBD was not associated with a poor kidney outcome in comparison with IgAN without IBD group (HR = 0.72, 95%CI: [0.3 - 2], p = 0.51). Conclusions: this first case series suggests that IBD-associated IgAN and primary IgAN have similar clinic biological presentation and evolution.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03202232
Contributor : Université Paris Descartes - Scd Connect in order to contact the contributor
Submitted on : Thursday, May 6, 2021 - 4:02:14 PM
Last modification on : Tuesday, September 7, 2021 - 3:23:51 AM

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Nizar Joher. Étude rétrospective multicentrique de néphropathies à dépôts d’immunoglobuline A associées aux maladies inflammatoires chroniques de l’intestin. Médecine humaine et pathologie. 2019. ⟨dumas-03202232⟩

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