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The effect of immunosuppressive therapy in patients with fibrinoid necrosis lesions in a large cohort of patients with IgA nephropathy

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Abstract

Background

Fibrinoid necrosis is considered one of the active pathological lesions in IgA nephropathy. Whether patients with IgA nephropathy with fibrinoid necrosis lesions benefit from immunosuppressive therapy in terms of long-term outcomes remains uncertain. This study aimed to evaluate the response to immunosuppressive therapy in patients with fibrinoid necrosis lesions in a large cohort of patients with IgA nephropathy.

Methods

A total of 1325 patients with kidney biopsy-proven IgA nephropathy from 1994 to 2016 were recruited from the Peking University First Hospital IgA Nephropathy Database. The clinicopathological characteristics of patients with fibrinoid necrosis lesions and the effect of immunosuppressive therapy on patients with fibrinoid necrosis lesions alone or in those with fibrinoid necrosis together with crescents or endocapillary hypercellularity lesions were analyzed.

Results

In total, 107/1325 (8.1%) patients showed fibrinoid necrosis lesions, and 92/107 (86.0%) of these patients showed fibrinoid necrosis associated either with cellular/fibrocellular crescents or endocapillary hypercellularity lesions. The presence of fibrinoid necrosis together with crescents or endocapillary hypercellularity was an independent risk factor for the kidney composite endpoint (HR, 2.11; 95% CI, 1.16–3.84; P = 0.02) in patients without immunosuppression, while for those receiving immunosuppressive therapy, kidney outcome was improved (HR, 0.80; 95% CI, 0.46–1.39; P = 0.42). However, the predictive value of fibrinoid necrosis lesions alone did not change significantly between patients with and without immunosuppressive therapy.

Conclusions

The presence of fibrinoid necrosis with crescents or endocapillary hypercellularity lesions together, but not fibrinoid necrosis lesions alone, was a pathological indicator of patients who may benefit from immunosuppressive therapy.

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Availability of data and material

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by the Beijing Natural Science Foundation (Grant No. 7192209), Chinese Academy of Medical Sciences Research Unit (No. 2019RU023), Capital of Clinical Characteristics and the Applied Research Fund (Z161100000516005).

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Authors and Affiliations

  1. Renal Division, Department of Medicine, Key Laboratory of Renal Disease, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Ministry of Health of China, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, People’s Republic of China

    Yingman Guo, Sufang Shi, Xujie Zhou, Lijun Liu, Jicheng Lv, Li Zhu, Suxia Wang & Hong Zhang

  2. Electron Microscopy Laboratory, Peking University First Hospital, Beijing, China

    Suxia Wang

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  1. Yingman Guo
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Contributions

YG: data collection, statistical analysis, and manuscript writing. XZ, JLv, LL, LZ: patient follow-up. SW: pathology score. S S: designed, supervised the study and revised it critically. HZ: manuscript review. All authors provided final manuscript approval.

Corresponding author

Correspondence to Sufang Shi.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethics approval

The study was approved by the ethics committee of Peking University First Hospital (2013[548]). and was executed in accordance with the principle of the Helsinki Declaration.

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Written informed consent was obtained from each patient and the copy of the written consent is available upon request.

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Informed written consent was obtained from each patient for publication of their collected and analyzed data.

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Guo, Y., Shi, S., Zhou, X. et al. The effect of immunosuppressive therapy in patients with fibrinoid necrosis lesions in a large cohort of patients with IgA nephropathy. J Nephrol 35, 1079–1089 (2022). https://doi.org/10.1007/s40620-021-01176-x

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  • DOI: https://doi.org/10.1007/s40620-021-01176-x

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