关键词: IgA肾病, 微小病变肾病, 临床病理, 治疗, 预后

Abstract:

 ABSTRACT Objective: To investigate the clinic-pathological characteristics, treatment response and prognosis of IgA nephropathy patients with minimal change lesion (MCD-IgAN). Methodology: Eighty patients with biopsy-proven MCD-IgAN and followed for ≥3 years from the Jinling Hospital IgA nephropathy Registry were enrolled into this retrospective study, and 77 patients with MCD were regarded as disease control. The clinic-pathological characteristics, treatment response and prognosis were compared with between two groups. Results: The clinical presentations were similar between the two groups, both with young male predominance, the majority of these patients presented with nephrotic syndrome, only few MCD-IgAN had varying degrees of macroscopic hematuria. Compared with the MCD group, patients with MCD-IgAN had lower levels of baseline serum albumin (P <0.01) and eGFR (P<0.01), higher levels of urinary n-acetyglucosaminidase and retino-bingding protein (P <0.01). The pathological features showed more severe acute and chronic tubulointerstitial injury in patients with MCD-IgANrenal pathology (P <0.01, P <0.05, respectively), while the glomerular lesion was similar between two groups. After 8 weeks of corticosteroid therapy, no significant differences were observed in the rate of complete remission, partial remission and no remission between MCD-IgAN and MCD (88.8% vs 90.9%, 10.0% vs 5.2%, 1.3% vs 3.9%, P>0.05). The median time to achieve remission was 4 weeks (range 1-24 weeks) and 4 weeks (range 1-28 weeks) respectively. During the three-year follow-up period, there was a significantly lower rate of relapse in MCD-IgAN patients than that in MCD patients (45.0% vs 63.6%, P <0.05). No patients between two groups entered ESRD, only 2 patients (2.5%) with MCD-IgAN had greater than 50% reduction of eGFR. Conclusion: The clinical manifestations, pathological features, response to corticosteroid therapy and renal outcome were similar between MCD-IgAN and MCD.

Key words: IgA nephropathy, minimal change disease, clinic-pathological features, treatment, prognosis