| IgA nephropathy (IgAN) is a common kind of glomerular disease. Patients with IgAN vary in the pathogenesis, the clinical presentation, the pathological pattern and the response to the treatment responses. Although a better understanding of pathogenic mechanisms, there is no disease-targeted treatment for IgAN. As an immune mediated kidney disease, glomerular endocapillary hypercellularity, crescent formation and necrosis were not rare in the patients with IgAN. It is important to know what these active proliferative lesions mean. Patients with these proliferative lesions have a high incidence of hypertension, nephrotic-range proteinuria and impaired renal function, and have been considered as a strong indication of immonusuppresive therapy. However, whether the proliferative lesions can be reversed after the immunosuppressive treatment and whether the reversal is associated with the prognosis of the disease have not been well established. To answer the questions, we conducted a retrospective study to evaluate the changes of renal pathological lesions after the immunosuppressive treatment in the patients with IgAN and their association with disease outcome.Part â… :Association between Histological Features and Clinical Manifestation in the Patients with IgA NephropathyObjective:To observe the histological features at the first and second biopsies in the patients with IgA nephropathy (IgAN), and analyze the association between the histological features and clinical manifestation.Methods:Ninety-nine patients with IgAN who received repeat biopsies were recruited in this study. The renal pathological lesions were reviewed and scored according to the Oxford classification of IgAN.Results:At either the first or second renal biopsy, the level of hematuria was associated with glomerular endocapillary hypercellularity (E), crescent formation(C) and necrosis (N), the level of proteinuria was associated with lesion C, and the level of renal function was associated with tubular atrophy/interstitial fibrosis (T). In the patients with the proliferative lesions (lesions E, C and N) at the first biopsy but without at the second biopsy (n= 47), their median level of proteinuria decreased from the first to second biopsy, the change of proteinuria differed to the patients with the proliferative lesions at both biopsies (n= 21) significantly. According to changes of clinical features, the patients were divided into improved group, stable group and progress group. The difference in the use of immunosuppressant between improved group and progress group was significant (76.2% vs 40.0%, P< 0.01). At the second biopsy, the presence of lesions E, C and N in improved group decreased significantly, while the presence of lesions C and N in progress group were without change. The presence of lesion T in each group increased, and no patient with improvement of lesion T. Glomerular mesangial hypercellularity (M) and segmental glomerulosclerosis (S) had no association with clinical features in this study.Conclusion:Glomerular proliferative lesions (lesions E, C and N) in the patients with IgAN were associated to the levels of proteinuria and hematuria closely, and the reversal of these lesions was accompanied with decreased proteinuira. Lesion T was associated with the renal function, and this lesion was irreversible.Part â…¡:Changes of the Renal Proliferative Lesions after Immunosuppressive Therapy in the Patients with IgA NephropathyObjective:Changes of the renal pathological lesions after the immunosuppressive treatment in the patients with IgA nephropathy (IgAN) and their association with the prognosis have not been established.Methods:Sixty patients with IgAN who received repeat biopsies after the immunosuppressive treatment were recruited in this study. The renal pathological lesions were reviewed and scored according to the Oxford classification of IgAN. End point was defined as a 30% reduction in estimated glomerular filtration rate (eGFR) or end stage renal disease (ESRD) after the second biopsy.Results:The presence of glomerular endocapillary hypercellularity (E), crescent formation (C) and necrosis (N) decreased markedly after the immunosuppressive therapy (36.7% vs 8.3%, P< 0.001; 85.0% vs 25.0%, P< 0.001; and 51.7% vs 3.3%, P< 0.001). In the patients with the lesions E, C or N at the first biopsy but reversed at the second biopsy, the median levels of proteinuria and hematuria were decreased significantly. Such clinical changes were not observed in those with the proliferative lesions at both biopsies. The presence of tubular atrophy/interstitial fibrosis (T) increased from 23.3% to 50.0%,26.7% of the patients were with lesion T at the second biopsy but without at the first biopsy, and no patient was with lesion T at the first biopsy but without at the second biopsy, the change of lesion T was significant (P < 0.001). In contrast, the presence of glomerular mesangial hypercellularity (M) and segmental glomerulosclerosis (S) did not differ from first to second biopsies.Conclusions:The glomerular proliferative lesions (lesions E, C and N) can be reversed after the immunosuppressive treatment in patients with IgAN. The reversal of these lesions was accompanied with improvement in proteinuria and hematuria. The immunosuppressive treatment should be considered in IgAN patients with proliferative lesions.Part â…¢:Association between the Histological Features and Renal Outcome in the Patients with IgA NephropathyObjective:To observe the histological features at the first and second biopsies in the patients with IgA nephropathy (IgAN), and analyze the association between the histological features and renal outcome.Methods:Ninety-two patients with IgAN who received repeat biopsies were recruited in this study. The renal pathological lesions were reviewed and scored according to the Oxford classification of IgAN. End point was defined as a 30% reduction in estimated glomerular filtration rate (eGFR) or end stage renal disease (ESRD) after the second biopsy.Results:At the first renal biopsy, glomerular mesangial hypercellularity (M), segmental glomerulosclerosis (S), endocapillary hypercellularity (E), crescent formation (C) and necrosis (N) and tubular atrophy/interstitial fibrosis (T) were present in 32.6%,88.0%,31.5%,63.0%,38.0% and 21.7% of the patients, respectively. At the second biopsy, these lesions were present in 30.4%,90.2%,7.6%, 27.2%,8.7% and 47.8% of the patients, respectively. After a median follow-up of 88 months,38.0%(n= 35) of the patients reached the end point. The association between the pathological lesions at the first biopsy and the renal outcomes were analyzed using COX regression analyses. Univariate COX analyses demonstrated that the renal outcomes were associated with lesions M, E, C, N and T. Multivariate COX analyses showed a significant association was observed between lesion C and T and renal outcome. The associations for the pathological lesions at the second biopsy were also analyzed. Univariate COX analyses demonstrated that the renal outcomes were associated with lesions M, S and T. Multivariate COX regression analyses showed a significant association was observed between lesion T and the renal outcome.Conclusions:Repeat renal biopsy confirmed that the powerful predictive value for lesion T in patients with IgAN. |
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