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Epidemiology of IgA Nephropathy

  Epidemiology of IgA Nephropathy

  The most common GN globally is IgA nephropathy (IgAN). Prevalence varies geographically, and estimates of disease burden vary according to whether ascertained using biopsy registry data versus dialysis registries. Despite these caveats, biopsy and organ replacement registries suggest geographic variation in disease burden with a higher incidence in Pacific Asian regions.

  Biopsy registry data underestimate disease burden as patients with mild disease may not undergo biopsy, and in countries lacking screening programs disease may not be detected. Distinguishing the contribution of ancestry and geography to differential disease susceptibility using biopsy registry data is further challenged by substantial geographic variation in biopsy practice patterns (e.g., for clinical indication versus mandatory military screening). A systematic review of biopsy-based studies spanning multiple countries suggests an overall population incidence of at least 2.5 per 100,000 (1). Only one study in this review was from Japan, and most were from Europe and North America. In children, the incidence in a Japanese biopsy registry study where broad screening programs were in place was eight-fold higher compared with a Tennessee program where biopsies were performed for-cause and routine screening was not in place (4.5 versus 0.57 per 100,000/yr) (2,3).

  Compelling data from autopsy and donor registries support that there is a higher burden of IgAN in East and Pacific Asian countries. Lanthanic IgA deposition is detected in 1.3% of autopsies of trauma victims in Finland compared with 15.6% of deceased donor candidates in Japan (4,5), suggesting that regional variabilities in incidence are not simply attributable to variation in biopsy practices. These findings parallel geospatial differences in prevalence of genetic susceptibility loci reported in global genome-wide association studies (6).

  Pooled cohorts from the European Validation Study of the Oxford Classification of IgA Nephropathy (VALIGA) and North American cohorts indicate rates ESRD or halving of eGFR of 27% at 10 years (7). There are regional differences in the progression of disease, however these are difficult to ascertain given lead-time biases introduced by variation in biopsy practice. In our cohort of 669 patients, multivariable analysis demonstrated that individuals of Pacific Asian origin have an increased risk of ERSD (adjusted hazard, 1.56; 95% confidence interval [95% CI], 1.1 to 2.22) (8).

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