Research Article

Immunoglobulin A Nephropathy Associated with Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort

Volume: 52 October 14, 2026
EN TR

Immunoglobulin A Nephropathy Associated with Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort

Abstract

Immunoglobulin A nephropathy diagnosed in a patient who already has a chronic systemic illness is conventionally reported as secondary disease, although for most associations the evidence for causation is limited and the clinical course is poorly characterized. We examined which systemic diseases accompany the nephropathy and how far they relate to long-term outcome. We reviewed 46 adults with biopsy-proven immunoglobulin A nephropathy and a systemic disease documented at or before biopsy at a single center between 1992 and 2023, grouped as gastrointestinal/liver, infection, rheumatologic or malignancy. The primary outcome was kidney replacement therapy. Median age was 40 years and median follow-up 10 years. Psoriasis was the most frequent associated diagnosis (12 patients, 26.1%); no difference from the rest of the cohort could be demonstrated in presentation, histology or outcome (KRT 4/12 vs 11/34, p=1.000; composite outcome 7/12 vs 17/34, p=0.742), although with 12 patients these estimates are imprecise. Patients with malignancy had a much lower estimated glomerular filtration rate (29.0 vs 90.0 mL/min/1.73 m2, p<0.001), more nephritic syndrome (90.0% vs 13.0%, p<0.001) and more crescents (40.0% vs 8.7%, p=0.053). Overall, 15 patients (32.6%) required KRT, 10 (21.7%) died and 24 (52.2%) met the composite outcome. The 10-year cumulative incidence of KRT was 65.0% in the malignancy group against 4.3% in the rheumatologic group (p=0.016). Patients with psoriasis did not show more favorable outcomes than the rest of the cohort, although the size of this subgroup precludes a firm conclusion; since these patients are followed largely outside nephrology, periodic urinalysis might be considered, a suggestion drawn from a small single-center cohort rather than from tested evidence. The worst outcomes occurred in older patients presenting with advanced kidney impairment, most of whom had a malignancy, a group that may warrant closer nephrological follow-up.

Keywords

Supporting Institution

The study received no financial support from any funding organisation.

Ethical Statement

This study was approved by the Bursa Uludağ University Faculty of Medicine Clinical Research Ethics Committee (decision number 2023-27/37, dated 12 December 2023). The study was conducted in accordance with the principles of the Declaration of Helsinki. Owing to the retrospective design, the Ethics Committee waived the requirement for individual informed consent.

Thanks

Claude (Anthropic) was used to adapt the manuscript to the journal's style and formatting requirements and for English language and expression editing. All suggestions produced by the tool were reviewed and verified by the authors, who are entirely responsible for the scientific content and accuracy of the manuscript.

References

  1. 1. Turkmen A, Sumnu A, Cebeci E, et al. Epidemiological features of primary glomerular disease in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group. BMC Nephrol. 2020;21(1):481.
  2. 2. Suzuki H, Kiryluk K, Novak J, et al. The pathophysiology of IgA nephropathy. J Am Soc Nephrol. 2011;22(10):1795-1803.
  3. 3. Pitcher D, Braddon F, Hendry B, et al. Long-term outcomes in IgA nephropathy. Clin J Am Soc Nephrol. 2023;18(6):727-738.
  4. 4. Moriyama T, Tanaka K, Iwasaki C, et al. Prognosis in IgA nephropathy: 30-year analysis of 1,012 patients at a single center in Japan. PLoS One. 2014;9(3):e91756.
  5. 5. Barbour SJ, Coppo R, Zhang H, et al. Evaluating a new international risk-prediction tool in IgA nephropathy. JAMA Intern Med. 2019;179(7):942-952.
  6. 6. Tota M, Baron V, Musial K, et al. Secondary IgA nephropathy and IgA-associated nephropathy: a systematic review of case reports. J Clin Med. 2023;12(7):2726.
  7. 7. Pouria S, Feehally J. Glomerular IgA deposition in liver disease. Nephrol Dial Transplant. 1999;14(10):2279-2282.
  8. 8. Chiu HY, Huang HL, Li CH, et al. Increased risk of glomerulonephritis and chronic kidney disease in relation to the severity of psoriasis, concomitant medication, and comorbidity: a nationwide population-based cohort study. Br J Dermatol. 2015;173(1):146-154.

Details

APA
Güllülü Boz, S. E., Hunutlu, F. C., Erbaş Özlü, F. N., Sezen, M., Çalışır, A. İ., Soyak Kabaca, H., Gul, B., Oruç, A., Ersoy, A., Yavuz, M., Dilek, K., Güllülü, M., & Yıldız, A. (2026). Immunoglobulin A Nephropathy Associated with Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort. Journal of Uludağ University Medical Faculty, 52. https://doi.org/10.32708/uutfd.2027656
AMA
1.Güllülü Boz SE, Hunutlu FC, Erbaş Özlü FN, et al. Immunoglobulin A Nephropathy Associated with Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort. J Uludag Univ Med Fac. 2026;52. doi:10.32708/uutfd.2027656
Chicago
Güllülü Boz, Saide Elif, Fazıl Cagrı Hunutlu, Fatma Nur Erbaş Özlü, et al. 2026. “Immunoglobulin A Nephropathy Associated With Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort”. Journal of Uludağ University Medical Faculty 52 (October). https://doi.org/10.32708/uutfd.2027656.
EndNote
Güllülü Boz SE, Hunutlu FC, Erbaş Özlü FN, Sezen M, Çalışır Aİ, Soyak Kabaca H, Gul B, Oruç A, Ersoy A, Yavuz M, Dilek K, Güllülü M, Yıldız A (October 1, 2026) Immunoglobulin A Nephropathy Associated with Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort. Journal of Uludağ University Medical Faculty 52
IEEE
[1]S. E. Güllülü Boz et al., “Immunoglobulin A Nephropathy Associated with Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort”, J Uludag Univ Med Fac, vol. 52, Oct. 2026, doi: 10.32708/uutfd.2027656.
ISNAD
Güllülü Boz, Saide Elif - Hunutlu, Fazıl Cagrı - Erbaş Özlü, Fatma Nur - Sezen, Mehmet - Çalışır, Abdullah İbrahim - Soyak Kabaca, Halime - Gul, Bulent et al. “Immunoglobulin A Nephropathy Associated With Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort”. Journal of Uludağ University Medical Faculty 52 (October 1, 2026). https://doi.org/10.32708/uutfd.2027656.
JAMA
1.Güllülü Boz SE, Hunutlu FC, Erbaş Özlü FN, Sezen M, Çalışır Aİ, Soyak Kabaca H, Gul B, Oruç A, Ersoy A, Yavuz M, Dilek K, Güllülü M, Yıldız A. Immunoglobulin A Nephropathy Associated with Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort. J Uludag Univ Med Fac. 2026;52. doi:10.32708/uutfd.2027656.
MLA
Güllülü Boz, Saide Elif, et al. “Immunoglobulin A Nephropathy Associated With Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort”. Journal of Uludağ University Medical Faculty, vol. 52, Oct. 2026, doi:10.32708/uutfd.2027656.
Vancouver
1.Saide Elif Güllülü Boz, Fazıl Cagrı Hunutlu, Fatma Nur Erbaş Özlü, Mehmet Sezen, Abdullah İbrahim Çalışır, Halime Soyak Kabaca, Bulent Gul, Ayşegül Oruç, Alparslan Ersoy, Mahmut Yavuz, Kamil Dilek, Mustafa Güllülü, Abdülmecit Yıldız. Immunoglobulin A Nephropathy Associated with Systemic Disease: Clinical Spectrum and Long-Term Kidney Outcomes in a Single-Center Cohort. J Uludag Univ Med Fac. 2026 Oct. 1;52. doi:10.32708/uutfd.2027656

ISSN: 1300-414X, e-ISSN: 2645-9027

Creative Commons License
Journal of Uludag University Medical Faculty is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
2023