Epidemiology of IgA Nephropathy: A Global Perspective

doi:10.1016/j.semnephrol.2018.05.013

Seminars in Nephrology

Volume 38, Issue 5, September 2018, Pages 435-442

https://doi.org/10.1016/j.semnephrol.2018.05.013 Get rights and content

Summary: IgA nephropathy (IgAN), or Berger's disease, is the most common primary glomerular disease worldwide, but varies largely in its geographic distribution. A systematic review of 1,619 publications from the five continental regions of the world was performed to assess the prevalence of IgAN in different worldwide regions and analyze factors responsible for geographic differences. All observational studies that described the prevalence and incidence data on glomerulonephritis were considered. IgAN is more frequent in Asian populations (45 cases per million population/y in Japan) than in Caucasians (31 cases per million population/y in France). These differences are owing to some relevant aspects: (1) systematic mass screening of urine in populations, as occurring in some Asian countries (Hong Kong, Japan, Korea, and Singapore), is not common in Western countries; (2) general practitioners and health care professionals in Western countries underestimate persistent microscopic hematuria and/or mild proteinuria in apparently healthy individuals causing late referral to a nephrologist; and (3) nephrologists adopt different indications for kidney biopsy in individuals with persistent urinary abnormalities. In addition, differences also are owing to the source of data, because the frequency of IgAN observed in a nephrology center with a high incidence of kidney biopsies is higher than in a regional renal biopsy registry that receives data from many centers. In conclusion, greater efforts should be made to diagnose IgAN earlier in individuals who manifest persistent microhematuria and/or mild proteinuria and to introduce less stringent indications for kidney biopsies. This preventive approach, followed by early therapy, may reduce the global burden of end-stage kidney disease caused by IgAN.

Section snippets

METHODS

Medline, Embase, and Science Direct databases (1968 to February 2017) were searched for publications on epidemiologic data regarding IgAN using the following terms: IgA nephropathy, Berger's disease, IgA nephritis, IgA glomerulonephritis, kidney biopsy registry, incidence, prevalence, and frequency. No language restriction filter was applied. All articles obtained by the search were reviewed and, when accepted, were included in the review.

Publications on the frequency of IgAN were obtained from

Systematic Review

Figure 1 shows the results of the database search. We collected 1,619 publications through database searching and 59 additional records were identified by other sources (conference proceedings and current awareness alerts).

In the screening phase, 1,281 reports were excluded, then among the 397 full-text articles assessed for eligibility 278 were further excluded for other reasons. Thus, 119 articles were included in the study. Details on the prevalence of the disease in each country are shown

DISCUSSION

This systematic review of the frequency of IgAN in the five continental regions of the world arose from a need to determine the worldwide burden of this disease, which remains the most common cause of ESKD among children with permanent urinary abnormalities and young adult patients with biopsy-proven primary glomerular disease.

The onset of IgAN is asymptomatic in many cases; therefore, routine urinalysis plays an important role not only for early diagnosis, but also for early therapeutic

AcknowledgmentS

Both authors contributed equally to this systematic review. The authors thank Prof. H Yokoyama, Chairman of the Japanese Renal Biopsy Registry, for permission to use Figure 2.

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IgA nephropathy (IgAN) stands as the most prevalent form of glomerulonephritis and ranks among the leading causes of end-stage renal disease worldwide. Regrettably, we continue to grapple with the absence of dependable diagnostic markers and specific therapeutic agents for IgAN. Therefore, this study endeavors to explore novel biomarkers and potential therapeutic targets in IgAN, while also considering their relevance in the context of tumors.
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We obtained 1391 differentially expressed genes (DEGs) in GSE93798 and 783 DGEs in GSE14795, respectively. identifying 69 common genes for further investigation. Subsequently, GMFG was identified the hub gene based on machine learning. In the verification set and the training set, the GMFG was higher in the IgAN group than in the healthy group and all of the GMFG area under the curve (AUC) was more 0.8. In addition, GMFG has a close relationship with the prognosis of malignancies and a range of immune cells.
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Immunoglobulin A nephropathy (IgAN) has been reported to coexist with hepatitis B virus (HBV) infection. Despite the clinical significance of this association, there is a lack of comprehensive research investigating the impact of various common conditions following HBV infection and the potential influence of anti-HBV therapy on the progression of IgAN.
We investigated 3 distinct states of HBV infection, including chronic HBV infection, resolved HBV infection, and the deposition of hepatitis B antigens in renal tissue, in a follow-up database of 1961 patients with IgAN. IgAN progression was defined as a loss of estimated glomerular filtration rate (eGFR) >40%. Multivariable cause-specific hazards models to analyze the relationship between HBV states and IgAN progression.
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Chronic HBV infection is an independent risk factor for IgAN progression, whereas resolved HBV infection is not. In patients with IgAN, management of concurrent chronic HBV infection should be enhanced. The presence of HBV deposition in the kidneys and the use of anti-HBV medications do not impact the kidney disease progression in patients with IgAN with concurrent HBV infection.
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In the comprehensive assessment of IgAN prognosis, the Random Forest model, employing molecular biomarkers, demonstrated strong performance metrics (AUC = 0.83, sensitivity = 0.51, specificity = 0.96). However, traditional graph feature engineering on patient-specific networks outperformed these results with an AUC of 0.90, sensitivity of 0.64, and specificity of 0.94. The Auto-encoder model showed the best accuracy (AUC = 0.91, sensitivity = 0.46, specificity = 0.96). The findings highlighted the superior predictive capabilities of network biomarkers over molecular biomarkers for adverse renal outcome prediction in IgAN. Consequently, we integrated Auto-encoder-derived Network Biomarkers with Random Forest Models to enhance prognostic precision in diverse IgAN treatment scenarios. The prediction for the prognosis of patients receiving supportive care, glucocorticoid therapy, and immunosuppressant treatment yielded AUC values of 0.95, 0.96, and 1, respectively, indicating high specificity. Drawing from these insights, we pioneered the development of an innovative decision support model for IgAN treatment. This model demonstrated the ability to make medical decisions comparable to those by experienced nephrologists, enabling the customization of personalized disease management strategies.
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: Financial disclosure and conflict of interest statements: Article publication has been supported by the Schena Foundation.

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Epidemiology of IgA Nephropathy: A Global Perspective

Section snippets

METHODS

Systematic Review

DISCUSSION

AcknowledgmentS

Am J Kidney Dis

Variations according to period and age. Kidney Int.

Kidney Int

Kidney Int

Hum Pathol

Am J Kidney Dis

Kidney Int

Pathology

Kidney Int

Kidney Int

Am J Kidney Dis.

Am J Kidney Dis

Kidney Int

Am J Kidney Dis

Kidney Int

Intercapillary deposits of IgA-IgG

J Urol Nephrol (Paris)

The incidence of primary glomerulonephritis worldwide: a systematic review of the literature

Nephrol Dial Transplant

The changing pattern of primary glomerulonephritis in Singapore and other countries over the past 3 decades

Clin Nephrol

Countries and Regions of the World from A to Z: A World Countries List

Epidemiology, major outcomes, risk factors, prevention and management of chronic kidney disease in China

Am J Nephrol

Global evolutionary trend of the prevalence of primary glomerulonephritis over the past three decades

Nephron Clin Pract

Ministry of Health and Welfare, Tokyo, Japan: Nationwide and long-term survey of primary glomerulonephritis in Japan as observed in 1,850 biopsied cases

Nephron

Japan Renal Biopsy Registry and Japan Kidney Disease Registry: committee report for 2009 and 2010

Clin Exp Nephrol.

Nationwide biopsy survey of renal diseases in the Czech Republic during the years 1994-2011

J Nephrol

Survey of the Italian Registry of Renal Biopsies. Frequency of the renal diseases for 7 consecutive years. The Italian Group of Renal Immunopathology

Nephrol Dial Transplant.

Evolución de la frecuencia de las glomerulonefritis primarias y secundarias en España en los años 1991 y 1992

Nefrologia

Report on management of renal failure in Europe, XXIV, 1993

Nephrol Dial Transplant.

Military nephrology: a review of cases 1985-2011

J R Army Med Corps

Isolated glomerulonephritis with mesangial IgA deposits

Br Med J

IgA nephropathy is not a rare disease in the United Kingdom

Nephron

Pediatric IgA nephropathy: clinical features at presentation and outcome for African-Americans and Caucasians

Clin Nephrol

Increased recognition of IgA nephropathy in African-American children

Pediatr Nephrol

Familial IgA nephropathy. Evidence of an inherited mechanism of disease

N Engl J Med

Epidemiology of IgA nephropathy in central and eastern Kentucky for the period 1975 through 1994. Central Kentucky Region of the Southeastern United States IgA Nephropathy DATABANK Project

J Am Soc Nephrol

Changing incidence of glomerular disease in Olmsted County, Minnesota: a 30-year renal biopsy study

Clin J Am Soc Nephrol

Kideny disease screening program in Japan: history, outcome and perspectives

Clin J Am Soc Nephrol

The incidence of biopsy-proven glomerulonephritis in Australia

Nephrol Dial Transplant