Key pathological features characterize minimal change disease-like IgA nephropathy

Tsung Yueh Wang, Fu Pang Chang, An Hang Yang, Shuk Man Ka, Ann Chen, Jyh Tong Hsieh, Fan Yu Chen, Tsung Lun Lee, Po Yu Tseng, Ming Tsun Tsai, Szu Yuan Li, Chih Yu Yang*, Jinn Yang Chen, Chih Ching Lin, Der Cherng Tarng

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims A subset of IgA nephropathy (IgAN) patients exhibiting minimal change disease (MCD) like features present with nephrotic-range proteinuria and warrants immunosuppressive therapy (IST). However, the diagnosis of MCD-like IgAN varied by reports. We aimed to identify the key pathological features of MCD-like IgAN. Methods In this cohort, 228 patients had biopsy-proven IgAN from 2009 to 2021, of which 44 without segmental sclerosis were enrolled. Patients were classified into segmental (< 50% glomerular capillary loop involvement) or global (> 50%) foot process effacement (FPE) groups. We further stratified them according to the usage of immunosuppressant therapy after biopsy. Clinical manifestations, treatment response, and renal outcome were compared. Results 26 cases (59.1%) were classified as segmental FPE group and 18 cases (40.9%) as global FPE group. The global FPE group had more severe proteinuria (11.48 [2.60, 15.29] vs. 0.97 [0.14, 1.67] g/g, p = 0.001) and had a higher proportion of complete remission (81.8% vs. 20%, p = 0.018). In the global FPE group, patients without IST experienced more rapid downward eGFR change than the IST-treated population (-0.38 [-1.24, 0.06] vs. 1.26 [-0.17, 3.20]mL/min/1.73 m2/month, p = 0.004). Conclusions The absence of segmental sclerosis and the presence of global FPE are valuable pathological features that assist in identifying MCD-like IgAN.

Original languageEnglish
Article numbere0288384
JournalPLoS ONE
Volume18
Issue number7 July
DOIs
StatePublished - Jul 2023

Fingerprint

Dive into the research topics of 'Key pathological features characterize minimal change disease-like IgA nephropathy'. Together they form a unique fingerprint.

Cite this