Factors Affecting The Efficacy And Prognosis Of Immunosuppressive Treatment Of IgA Nephropathy

Background and objectiveIgA nephropathy(IgA nephropathy,IgAN)is the most common primary glomerulonephritis in China.IgAN is confirmed by the presence of dominant or codominant mesangial deposits of IgA on renal biopsy.It is currently believed that the occurrence of IgAN is an autoimmune disease caused by a variety of pathophysiological processes.Therefore,many studies believe that immunosuppressive therapy is effective for IgAN.However,there are significant differences in the response of IgAN patients to immunosuppressive therapy.as well as in the renal prognosis.of patients after immunosuppressive therapy,and the differences may be related to the diversity of clinical manifestations and pathological changes of IgAN.Some retrospective and observational studies have shown that active proliferative lesions respond to immunosuppressive therapy,and that pathological features and clinical features have a certain degree of correlation.However,which characteristics affect the outcome of immunosuppressive therapy,and whether clinical pathological characteristics have predictive value for IgAN,there are currently few studies.This study retrospectively analyzed the clinicopathological characteristics of IgAN patients treated by immunosuppressive therapy,analyzed the correlation between clinical characteristics and pathological indicators,and analyzed the related factors influencing the immunosuppressive treatment effect and prognosis of IgAN.MethodsThis study is a retrospective cohort study.97 patients who were hospitalized in the Third Department of Nephrology,the First Affiliated Hospital of Zhengzhou University from June 2014 to June 2019,and were diagnosed as IgAN by renal biopsy and received immunosuppressive therapy were enrolled in the study.The endpoint was defined as serum creatinine doubling the baseline value,progression to ESRD,or death because of a kidney disease.Collect clinical data during renal biopsy of patients,including serum albumin,24-h urinary protein quantification,serum creatinine,triglyceride,systolic pressure,diastolic pressure and other clinical characteristics,as well as the results of Oxford pathological classification.record the period of immunosuppressive treatment 24-h urinary protein quantification,serum creatinine,serum albumin and adverse reactions.Record the time the patient reaches the endpoint or follow-up time.Analyze the correlation between Oxford classification and clinical characteristics.The outcomes of immunosuppressive therapy was evaluated,and the factors influencing the outcomes of immunosuppressive therapy were analyzed by logistics regression.Kaplan-Meier curve and Cox regression were used to analyze the influence of clinicopathological indicators on renal prognosis.ResultsDuring the follow-up period,a total of 30 patients(30.9%)reached the endpoint event,and the incidence of the endpoint event in the remission group and non-remission group was 9.8%(6/61)and 66.7%(24/36),respectively.Compared with the remission group,the non-remission group had a higher incidence of reaching the endpoint(P<0.001).The overall follow-up time was 31.1±15.7 months,the follow-up time of the remission group was 35.7±14.7 months,and the follow-up time of the non-remission group was 23.2±14.3 months.Clinical indicators on renal biopsy are related to renal pathological changes.The lower the eGFR or the higher the triglyceride on renal biopsy,it indicates that the degree of renal tubular atrophy/interstitial fibrosis is more serious(P<0.05);The higher proteinuria level on renal biopsy,the more serious the proliferation of mesangial cells and capillaries.Multivariate logistic regression analysis showed that S1(OR=63.905)and proteinuria(OR=4.523)were the risk factors for the immunosuppressive treatment effect in IgAN patients,and eGFR(OR=0.153)was the protective factor for the immunosuppressive treatment effect in IgAN patients.The ROC curve suggested that the best threshold of eGFR and proteinuria on renal biopsy was 41.59mL/min/1.73m2 and 2.65g/24h,respectively to to predict the efficacy of immunosuppressive therapy.That was,when eGFR was above 41.59mL/min/1.73m2 or proteinuria was below 2.65g/24h,the efficacy of immunosuppressive therapy might be better.Multivariate Cox regression analysis showed that the severity of renal tubular atrophy/interstitial fibrosis is an independent risk factor for poor renal prognosis in IgAN patients(P<0.05),and the risk of IgAN patients with T1 lesions progressing to the endpoint event is 10.082 times that of T0(95%CI 1.359～74.812,P=0.024),and the risk of IgAN patients with T2 lesions progressing to the endpoint event is 22.142 times(95%)of T0.CI 3.392～144.527,P=0.001).The risk of IgAN patients in the non-remission group that progressed to the endpoint event was 26.259 times that of the remission group(95%CI 4.990～138.178,P<0.001).Triglycerides each additional loglmmol/L,the risk of endpoint events in patients with IgAN progress to increased 3.509-fold(95%CI 1.362～9.038,P=0.009).ConclusionLevels of eGFR and proteinuria on renal biopsy,as well as the presence of S1 lesion,were independent factors that influenced the outcomes of immunosuppressive therapy in IgAN patients.The severity of T lesion and the triglyceride level on renal biopsy,the outcome of immunosuppresive therapy can independently predict the renal prognosis of IgAN patients who received immunosuppressive treatment.