Clinicopathological features and risk factors analysis of IgA nephropathy associated with acute kidney injury: A single-center retrospective study.

The aim of this study is to investigate the distinctive clinicopathological characteristics of acute kidney injury (AKI) in immunoglobulin A (IgA) nephropathy and identify the possible risk factors for AKI in IgA nephropathy. This study was a hospital-based retrospective analysis of clinicopthological data of IgA nephropathy. The study was conducted in the Department of Nephrology, Gauhati Medical College and Hospital, Assam, India from the period from January 2012 to December 2016. A total of 169 patients who met the inclusion or exclusion criteria were included in the study. Patient data (clinical/demographic and laboratory data including renal biopsy) were collected and were analyzed to assess the risk factors for AKI in IgA nephropathy. For the purpose of analyses, the patients were divided into two groups, AKI (n = 28) and non-AKI group (n = 141). Twenty-eight patients out of 169 developed AKI. The prevalence of AKI in IgA nephropathy patients in our center was 16.5% (28/169). Most AKI patients were hypertensive, hyperlipidemic, had pre-existing impaired kidney function, and higher baseline serum creatinine, higher serum uric acid, and proteinuria, with lower serum albumin and hemoglobin (P <0.05). Use of herbal medications was also significantly more common in the AKI group (P <0.003). Pathological features, like crescents (both cellular and fibrocellular) and interstitial fibrosis/tubular atrophy, were also more severe in the AKI group (P <0.003). In multivariate logistic regression analysis, we found that hypertension, proteinuria, cellular and fibro-cellular crescents, glomerular sclerosis were possible risk factors for AKI. Prevalence of AKI in IgA nephropathy is not as uncommon in north-eastern India as previously thought and knowledge of risk factors for AKI can help in early identification of individuals at risk.