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Reversal of active glomerular lesions after immunosuppressive therapy in patients with IgA nephropathy: a repeat-biopsy based observation

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Abstract

Background

Reversal of active glomerular lesions after immunosuppressive treatment in patients with IgA nephropathy (IgAN) and their association with prognosis have not been well established.

Methods

Sixty patients with IgAN who received repeat biopsies after immunosuppressive treatment were recruited. Reversal of renal pathological lesions was evaluated between the first and second biopsy. The end-point was defined as a 30 % reduction in estimated glomerular filtration rate (eGFR) or end-stage renal disease after the second biopsy.

Results

Active glomerular lesions, i.e. endocapillary hypercellularity (E), crescents (C) and necrosis (N) were markedly decreased at the second biopsy after 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). Patients with E, C or N at the first biopsy but reversed at the second biopsy showed significantly decreased median levels of proteinuria and hematuria. Such clinical changes were not observed in those with active lesions at both biopsies. After a median follow-up of 32 months, 25.0 % of patients reached the end-point. Repeat biopsy confirmed that only tubular atrophy/interstitial fibrosis was associated with the renal outcome.

Conclusions

Active glomerular lesions can be reversed by immunosuppressive treatment in patients with IgAN. The reversal is accompanied by improvement in proteinuria and hematuria. The reversal of these lesions during the disease process may explain the lack of significant correlation of these lesions with clinical outcomes in the present study as well as in previous evaluation studies of the Oxford classification of IgAN.

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Acknowledgments

We thank all patients and their families who participated in this study. This work was supported by the National Basic Research Program of China 973 Program No. 2012CB517600 (No. 2012CB517606).

Conflict of interest

All the authors declared no competing interests.

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Authors and Affiliations

  1. National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People’s Republic of China

    Xia-Hong Shen, Shao-Shan Liang, Hui-Mei Chen, Wei-Bo Le, Song Jiang, Cai-Hong Zeng, Min-Lin Zhou, Hai-Tao Zhang & Zhi-Hong Liu

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  1. Xia-Hong Shen
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  2. Shao-Shan Liang
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  3. Hui-Mei Chen
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  6. Cai-Hong Zeng
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  7. Min-Lin Zhou
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  8. Hai-Tao Zhang
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  9. Zhi-Hong Liu
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Corresponding author

Correspondence to Zhi-Hong Liu.

Additional information

X.-H. Shen and S.-S. Liang contributed equally to this work.

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Shen, XH., Liang, SS., Chen, HM. et al. Reversal of active glomerular lesions after immunosuppressive therapy in patients with IgA nephropathy: a repeat-biopsy based observation. J Nephrol 28, 441–449 (2015). https://doi.org/10.1007/s40620-014-0165-x

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  • DOI: https://doi.org/10.1007/s40620-014-0165-x

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