Key pathological features characterize minimal change disease-like IgA nephropathy

Tsung-Yueh Wang(Taipei Veterans General Hospital), Fu‐Pang Chang(National Yang Ming Chiao Tung University), An‐Hang Yang(National Yang Ming Chiao Tung University), Shuk‐Man Ka(National Defense Medical Center), Ann Chen(Tri-Service General Hospital), Jyh-Tong Hsieh(Taipei Veterans General Hospital), Fanyu Chen(Taipei Veterans General Hospital), Tsung‐Lun Lee(Taipei Veterans General Hospital), Po‐Yu Tseng(National Yang Ming Chiao Tung University), Ming‐Tsun Tsai(National Yang Ming Chiao Tung University), Szu‐Yuan Li(National Yang Ming Chiao Tung University), Chih‐Yu Yang(National Yang Ming Chiao Tung University), Jinn-Yang Chen(National Yang Ming Chiao Tung University), Chih‐Ching Lin(National Yang Ming Chiao Tung University), Der‐Cherng Tarng(National Yang Ming Chiao Tung University)
PLoS ONE
July 20, 2023
10.1371/journal.pone.0288384
Cited by 3Open Access
Full Text

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.

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