Glomerulonephritides are conditions in which the primary renal filters (glomeruli) are inflamed, leading to scarring and reduced function. Glomerulonephritides can be acute or chronic, and can be primary (in the case of immunoglobulin [Ig]A nephropathy [IgAN]) or secondary to infection or medications. Symptoms include haematuria, proteinuria, hypertension, and oedema. A common comorbidity of primary glomerulonephritis (PGN) is anaemia, defined by the World Health Organization (WHO) as haemoglobin (Hb) <12g/dL in women and <13g/dL in men. In a May publication in BMC Nephrology, Kanana Naghizade and colleagues sought to investigate the risk factors for anaemia in PGN, as well as the risk of anaemia in IgAN relative to other PGN subtypes.
The study authors utilised the Turkish Society of Nephrology Glomerulonephritis Database (TSN-GOLD) to select a cohort of 5,500 adult patients registered from 2005 to 2022. In this cohort, 1,571 patients (28.6%) had IgAN, 1,593 patients (29.0%) had focal segmental glomerulosclerosis (FSGS), 1,476 patients (26.8%) had membranous nephropathy (MN), 378 patients (6.9%) had minimal change disease (MCD), and 482 patients (8.8%) had membranoproliferative glomerulonephritis (MPGN). All PGN cases were confirmed via biopsy.
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The patients’ blood was analysed for Hb levels and clinical outcomes regardless of PGN type. Tests showed that as Hb increased, estimated glomerular filtration rate (eGFR) increased while blood urea nitrogen (BUN), creatinine, and sedimentation rate decreased, all of which are positive clinical indicators. Conversely, patients with low Hb levels exhibited increased histological damage, including tubular atrophy, interstitial inflammation, and mesangial proliferation.
The researchers performed a logistic regression analysis to determine potential predictors of anaemia in the cohort. They found that the risk of anaemia was lower in men (odds ratio [OR] = 0.0638, P<0.001), lower with increased serum albumin (OR = 0.580, P<0.001), and lower with increased proteinuria (OR = 0.964, P<0.001). However, the risk of anaemia increased with age (OR = 1.005, P = 0.041).
The researchers then compared the risk of anaemia between PGN subtypes. Patients with IgAN were at lower risk of anaemia than patients with MPGN (MPGN versus IgAN, OR = 1.787, P<0.001), but at higher risk than patients with MCD (MCD versus IgAN, OR = 0.568, P<0.001) or FSGS (FSGS versus IgAN, OR = 0.756, P<0.001). This is likely due to the clinical differences between the conditions, despite all three affecting kidney function. When the authors focused on the relationship between IgAN and anaemia, they determined that factors such as tubulointerstitial injury, haematuria, chronic inflammation, immune dysregulation, and even treatments for IgAN influence anaemia.
GlobalData epidemiologists forecast that there will be over 150,000 diagnosed prevalent cases of IgAN and over 1.3 million diagnosed prevalent cases of renal anaemia in the US in 2026. Establishing the risk of anaemia as a comorbidity of IgAN can give a fuller picture of the clinical outcomes of the disease and can guide management plans for patients with IgAN and other PGN.
