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Long-term outcome of IgA nephropathy with minimal change disease: a comparison between patients with and without minimal change disease

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Abstract

Background

The clinicopathological characteristics, treatment response and long-term outcome of immunoglobulin (Ig)A nephropathy with minimal change disease (MCD-IgAN) are not well defined.

Methods

Patients with biopsy-proven MCD-IgAN from the Jinling Hospital IgA nephropathy Registry were systematically reviewed and compared with those with IgA nephropathy without minimal change disease (Non-MCD-IgAN).

Results

We compared data of 247 MCD-IgAN patients and 1,121 Non-MCD-IgAN patients. Compared to Non-MCD-IgAN, MCD-IgAN patients were younger,with male predominance, had higher levels of proteinuria, total cholesterol and estimated glomerular filtration rate (eGFR), lower incidence of hypertension and microhematuria, lower level of serum creatinine, and had less severe glomerular, tubulointerstitial and vascular lesions in renal pathology. In the Non-MCD-IgAN group, 157 patients (14.0 %) reached the renal endpoint and 103 patients (9.2 %) entered end-stage renal disease (ESRD). The 5-,10-, 15- and 20-year cumulative renal survival rates from ESRD, calculated by Kaplan–Meier method, were 95.0, 83.0, 72.9 and 65.4 %, respectively. In the MCD-IgAN group, no patients entered ESRD and only 4 (1.6 %) reached the renal endpoint. Patients with MCD-IgAN had a significantly better renal outcome than Non-MCD-IgAN (p < 0.01). At multivariate Cox analysis, proteinuria >1.0 g/day, hypertension, eGFR <60 ml/min/1.73 m2, hypoproteinemia and hyperuricemia were independent risk factors of renal survival for Non-MCD-IgAN patients [hazard ratio (HR) 3.43, p < 0.001; HR 1.65, p < 0.05; HR 2.61, p < 0.001; HR 2.40, p < 0.001; HR 2.27, p < 0.001, respectively), but not for patients with MCD-IgAN.

Conclusions

The long-term outcome of patients with MCD-IgAN is significantly better than that of patients with Non-MCD-IgAN.

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References

  1. Koyama A, Igarashi M, Kobayashi M (1997) Natural history and risk factors for immunoglobulin A nephropathy in Japan. Research Group on Progressive Renal Diseases. Am J Kidney Dis 29:526–532

    Article  CAS  PubMed  Google Scholar 

  2. Le W, Liang S, Hu Y et al (2012) Long-term renal survival and related risk factors in patients with IgA nephropathy: results from a cohort of 1155 cases in a Chinese adult population. Nephrol Dial Transplant 27:1479–1485

    Article  CAS  PubMed  Google Scholar 

  3. Moriyama T, Itabashi M, Takei T et al (2015) High uric acid level is a risk factor for progression of IgA nephropathy with chronic kidney disease stage G3a. J Nephrol 28:451–456

    Article  CAS  PubMed  Google Scholar 

  4. Barbour SJ, Cattran DC, Kim SJ et al (2013) Individuals of Pacific Asian origin with IgA nephropathy have an increased risk of progression to end-stage renal disease. Kidney Int 84:1017–1024

    Article  CAS  PubMed  Google Scholar 

  5. Reich HN, Troyanov S, Scholey JW et al (2007) Remission of proteinuria improves prognosis in IgA nephropathy. J Am Soc Nephrol 18:3177–3183

    Article  CAS  PubMed  Google Scholar 

  6. Donadio JV, Bergstralh EJ, Grande JP et al (2002) Proteinuria patterns and their association with subsequent end-stage renal disease in IgA nephropathy. Nephrol Dial Transplant 17:1197–1203

    Article  CAS  PubMed  Google Scholar 

  7. Tanaka K, Moriyama T, Iwasaki C et al (2015) Effect of hematuria on the outcome of IgA nephropathy with mild proteinuria. Clin Exp Nephrol 19:815–821

    Article  CAS  PubMed  Google Scholar 

  8. Le W, Liang S, Chen H et al (2014) Long-term outcome of IgA nephropathy patients with recurrent macroscopic hematuria. Am J Nephrol 40:43–50

    Article  CAS  PubMed  Google Scholar 

  9. Cattran DC, Coppo R, Cook HT et al (2009) The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int 76:534–545

    Article  PubMed  Google Scholar 

  10. Zeng CH, Le W, Ni Z et al (2012) A multicenter application and evaluation of the oxford classification of IgA nephropathy in adult chinese patients. Am J Kidney Dis 60:812–820

    Article  PubMed  Google Scholar 

  11. Barratt J, Feehally J (2005) IgA nephropathy. J Am Soc Nephrol 16:2088–2097

    Article  CAS  PubMed  Google Scholar 

  12. Lai KN, Lai FM, Ho CP et al (1986) Corticosteroid therapy in IgA nephropathy with nephrotic syndrome: a long-term controlled trial. Clin Nephrol 26:174–180

    CAS  PubMed  Google Scholar 

  13. Cheng IK, Chan KW, Chan MK (1989) Mesangial IgA nephropathy with steroid-responsive nephrotic syndrome: disappearance of mesangial IgA deposits following steroid-induced remission. Am J Kidney Dis 14:361–364

    Article  CAS  PubMed  Google Scholar 

  14. Westhoff TH, Waldherr R, Loddenkemper C et al (2006) Mesangial IgA deposition in minimal change nephrotic syndrome: coincidence of different entities or variant of minimal change disease. Clin Nephrol 65:203–207

    Article  CAS  PubMed  Google Scholar 

  15. Barbiano DBG, Mazzucco G, Casanova S et al (1986) Steroid-sensitive nephrotic syndrome with mesangial IgA deposits: a separate entity? Observation of two cases. Am J Nephrol 6:141–145

    Article  Google Scholar 

  16. Gallego N, Gonzalo A, Mampaso F et al (1988) Steroid-dependent nephrotic syndrome with minimal glomerular changes and mesangial IgA deposits. Child Nephrol Urol 9:98–100

    PubMed  Google Scholar 

  17. Qin J, Yang Q, Tang X et al (2013) Clinicopathologic features and treatment response in nephrotic IgA nephropathy with minimal change disease. Clin Nephrol 79:37–44

    Article  CAS  PubMed  Google Scholar 

  18. Wang J, Juan C, Huang Q et al (2013) Corticosteroid therapy in IgA nephropathy with minimal change-like lesions: a single-centre cohort study. Nephrol Dial Transplant 28:2339–2345

    Article  CAS  PubMed  Google Scholar 

  19. Herlitz LC, Bomback AS, Stokes MB et al (2014) IgA nephropathy with minimal change disease. Clin J Am Soc Nephrol 9:1033–1039

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  PubMed  PubMed Central  Google Scholar 

  21. Waldman M, Crew RJ, Valeri A et al (2007) Adult minimal-change disease: clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol 2:445–453

    Article  CAS  PubMed  Google Scholar 

  22. Szeto CC, Lai FM, Chow KM et al (2015) Long-term outcome of biopsy-proven minimal change nephropathy in Chinese adults. Am J Kidney Dis 65:710–718

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nephroloy, Fuyang People’s Hospital, 236003, Fuyang, Anhui, China

    Xiao-Wei Li

  2. National Clinical Research Center of Kidney Diseases, Jinling Hospitial, Nanjing University of Medicine, 210002, Nanjing, Jiangsu, China

    Xiao-Wei Li, Shao-Shan Liang, Wei-Bo Le, Shui-Qin Cheng, Cai-Hong Zeng, Jin-Quan Wang & Zhi-Hong Liu

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  1. Xiao-Wei Li
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  2. Shao-Shan Liang
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Correspondence to Zhi-Hong Liu.

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The authors have no conflict of interest to declare.

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For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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Funding

This study was funded by the National Basic Research Program of China 973 Program No.2012CB517600 (No. 2012CB517606) and the National Science Foundation of China (810-2010-8016).

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Li, XW., Liang, SS., Le, WB. et al. Long-term outcome of IgA nephropathy with minimal change disease: a comparison between patients with and without minimal change disease. J Nephrol 29, 567–573 (2016). https://doi.org/10.1007/s40620-015-0242-9

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  • DOI: https://doi.org/10.1007/s40620-015-0242-9

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