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Towards better indications for kidney biopsy in adult IgA vasculitis: a clinical-laboratory and pathology correlation study

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Abstract

Background

Indications for kidney biopsy in adult IgA vasculitis (IgAV) remain debated and there are very few studies on this subject. The aim of this study was to establish a correlation between renal histological and clinical-laboratory data.

Methods

A retrospective multicenter study was conducted using three databases from French hospitals, gathered between 1977 and 2020. The study included 294 adult patients with IgAV who had undergone kidney biopsy assessed according to the prognostic “Pillebout classification”. Different statistical models were used to test the correlations between histological and clinical-laboratory data: Cochran Armitage, ANOVA, Kruskal–Wallis and logistic regression.

Results

The patients were primarily men (64%), with a mean age of 52 years. The main organs and tissues involved were: dermatological 100%, digestive 48% and rheumatological 61%. All had features of kidney involvement. The median serum creatinine was 96 µmol/L serum albumin 35 g/L, and C-reactive protein 28 mg/L. Of the patients, 86% (n = 254) had hematuria and median proteinuria was 1.8 g/day. The only statistically significant correlation between the pathological stages and the clinical-laboratory data was the presence of hematuria (p = 0.03, 66% class I to 92% class IV). In multivariate analysis, only albuminemia was associated with extracapillary proliferation (p = 0.02; OR 0.94) and only age was associated with stages 3–4 (p = 0.03; OR 1.02).

Conclusion

Our study suggests that there is no strict baseline correlation between renal pathology and clinical-laboratory data. Given the current knowledge, it seems relevant to recommend a kidney biopsy in the presence of significant and persistent proteinuria or unexplained kidney function decline.

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Abbreviations

CRP:

C-reactive protein

CNIL:

« Commission Nationale de l'Informatique et des Libertés»

eGFR:

Estimated glomerular filtration Rate

ESRD:

End-stage renal disease

GI:

Gastroenterological involvement

HSPN:

Henoch–Schönlein Purpura Nephritis

IgA:

Immunoglobulin A

IgAV:

IgA vasculitis

IQR:

Interquartile range

MDRD:

Modification of diet in renal disease

IgAN:

IgA nephropathy

Q1:

First quartile

Q3:

Third quartile

SD:

Standard deviation

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Acknowledgements

We warmly thank Amélie Le Gouge for her precious help in statistical management and the CHRU of Tours for its support.

Author information

Authors and Affiliations

  1. University of Tours, Tours, France

    Valentin Maisons, Jean-Michel Halimi, Yanis Ramdani, François Maillot & Alexandra Audemard-Verger

  2. Department of Nephrology, Hopital Bretonneau, CHRU de Tours, Tours, France

    Valentin Maisons, Jean-Michel Halimi & Christelle Barbet

  3. Department of Nephrology, Hopital Saint-Louis, APHP, Paris, France

    Évangeline Pillebout

  4. Department of Nephrology, CHU Limoges, Limoges, France

    Zhour El Ouafi

  5. Department of Nephrology, Hopital Européen Georges Pompidou, APHP, Paris, France

    Eric Thervet

  6. University Paris Descartes, Paris, France

    Eric Thervet & Benjamin Terrier

  7. Department of Internal Medicine, Hôpital Cochin, Paris, France

    Benjamin Terrier

  8. National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France

    Benjamin Terrier

  9. Department of Internal Medicine and Clinical Immunology, CHRU Tours, University of Tours, Tours, France

    Yanis Ramdani, François Maillot & Alexandra Audemard-Verger

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  1. Valentin Maisons
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  2. Jean-Michel Halimi
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  4. Évangeline Pillebout
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Contributions

VM, AAV: design, data analysis and writing. JMH, CB: design and writing. EP, ET, BT, ZEO, YR, FM: writing.

Corresponding author

Correspondence to Alexandra Audemard-Verger.

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Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

The content of this article confirmed to ethical guidelines of the Helsinki declaration (as revised in Tokyo 2004). Both Pillebout and IGAVAS databases had already been approved by the institutional review boards. Procedures for data collection and management of patients recruited in the nephrology department of the Tours university hospital were approved by the “Commission Nationale de l'Informatique et des Libertés” (CNIL), the independent National Ethics Committee protecting human rights in France (MR-004 registration number F20210304102053).

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Maisons, V., Halimi, JM., Barbet, C. et al. Towards better indications for kidney biopsy in adult IgA vasculitis: a clinical-laboratory and pathology correlation study. J Nephrol 36, 485–494 (2023). https://doi.org/10.1007/s40620-022-01389-8

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  • DOI: https://doi.org/10.1007/s40620-022-01389-8

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