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Clinical observation over two decades has shown that spontaneous remission may occur but that 15-20% of patients develop end stage renal failure within 10 years of diagnosis. The risk factors for progression are impaired renal function at presentation, heavy proteinuria, hypertension, and (curiously) absence of the typical symptom - recurrent macroscopic haematuria. The systemic nature of IgA nephropathy is shown convincingly by its recurrence in patients who receive a kidney transplant and, more remarkably, by the disappearance of IgA deposits when a kidney
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