Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role?
Background Nephrotic syndrome (NS) and nephrotic-range proteinuria (NRP) are uncommon in IgA nephropathy (IgAN), and their clinicopathology and prognosis have not been discussed. Podocytes may play an important role in both clinical phenotypes.Methods We investigated 119 biopsy-proven IgAN patients...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2022-12-01
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| Series: | Renal Failure |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2022.2113796 |
| _version_ | 1817999555391651840 |
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| author | Yizhen Chen Aicheng Yang Yuansheng Hou Longhui Liu Jiehua Lin Xiaodan Huang Jundu Li Xusheng Liu Fuhua Lu Qizhan Lin Haifeng Yang Shuling Yue Shujun Jiang Lixin Wang Chuan Zou |
| author_facet | Yizhen Chen Aicheng Yang Yuansheng Hou Longhui Liu Jiehua Lin Xiaodan Huang Jundu Li Xusheng Liu Fuhua Lu Qizhan Lin Haifeng Yang Shuling Yue Shujun Jiang Lixin Wang Chuan Zou |
| author_sort | Yizhen Chen |
| collection | DOAJ |
| description | Background Nephrotic syndrome (NS) and nephrotic-range proteinuria (NRP) are uncommon in IgA nephropathy (IgAN), and their clinicopathology and prognosis have not been discussed. Podocytes may play an important role in both clinical phenotypes.Methods We investigated 119 biopsy-proven IgAN patients with proteinuria over 2 g/d. The patients were divided into three groups according to proteinuria level: the overt proteinuria (OP) group, NS group, and NRP group. In addition, according to the severity of foot process effacement (FPE), the patients were divided into three groups: the segmental FPE (SFPE) group, moderate FPE (MFPE) group, and diffuse FPE (DFPE) group. The outcome was survival from a combined event defined by a doubling of the baseline serum creatinine and a 50% reduction in eGFR or ESRD.Results Compared with the NRP group, patients in the NS group had more severe microscopic hematuria, presented with more severe endocapillary hypercellularity and had a higher percentage of DFPE. The Kaplan–Meier curve showed that MFPE patients had a better outcome in the NRP group <50% of tubular atrophy/interstitial fibrosis. In the multivariate model, the NRP group (HR = 17.098, 95% CI = 3.835–76.224) was associated with an increased risk of the combined event, while MFPE (HR = 0.260, 95% CI = 0.078–0.864; p = 0.028) was associated with a reduced risk of the combined event. After the addition of renin-angiotensin system inhibitors (RASi), the incidence of the combined event in the MFPE group (HR = 0.179, 95% CI = 0.047–0.689; p = 0.012) was further reduced.Conclusions NS presented more active lesions and more severe FPE in IgAN. NRP was an independent risk factor for progression to the renal endpoint, while MFPE indicated a better prognosis in NRP without obvious chronic renal lesions, which may benefit from RASi. |
| first_indexed | 2024-04-14T03:10:29Z |
| format | Article |
| id | doaj.art-77fc798ea52b45d9862f96d14626cf85 |
| institution | Directory Open Access Journal |
| issn | 0886-022X 1525-6049 |
| language | English |
| last_indexed | 2024-04-14T03:10:29Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj.art-77fc798ea52b45d9862f96d14626cf852022-12-22T02:15:37ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492022-12-014411443145310.1080/0886022X.2022.2113796Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role?Yizhen Chen0Aicheng Yang1Yuansheng Hou2Longhui Liu3Jiehua Lin4Xiaodan Huang5Jundu Li6Xusheng Liu7Fuhua Lu8Qizhan Lin9Haifeng Yang10Shuling Yue11Shujun Jiang12Lixin Wang13Chuan Zou14Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Nephrology, The Affiliated Jiangmen TCM Hospital of Jinan University, Jiangmen, ChinaSecond Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Nephrology, The Affiliated Jiangmen TCM Hospital of Jinan University, Jiangmen, ChinaDepartment of Nephrology, The Affiliated Jiangmen TCM Hospital of Jinan University, Jiangmen, ChinaSecond Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, ChinaSecond Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Pathology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaGuangzhou Kingmed Diagnostic Laboratory Ltd, Guangzhou, ChinaDepartment of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, ChinaBackground Nephrotic syndrome (NS) and nephrotic-range proteinuria (NRP) are uncommon in IgA nephropathy (IgAN), and their clinicopathology and prognosis have not been discussed. Podocytes may play an important role in both clinical phenotypes.Methods We investigated 119 biopsy-proven IgAN patients with proteinuria over 2 g/d. The patients were divided into three groups according to proteinuria level: the overt proteinuria (OP) group, NS group, and NRP group. In addition, according to the severity of foot process effacement (FPE), the patients were divided into three groups: the segmental FPE (SFPE) group, moderate FPE (MFPE) group, and diffuse FPE (DFPE) group. The outcome was survival from a combined event defined by a doubling of the baseline serum creatinine and a 50% reduction in eGFR or ESRD.Results Compared with the NRP group, patients in the NS group had more severe microscopic hematuria, presented with more severe endocapillary hypercellularity and had a higher percentage of DFPE. The Kaplan–Meier curve showed that MFPE patients had a better outcome in the NRP group <50% of tubular atrophy/interstitial fibrosis. In the multivariate model, the NRP group (HR = 17.098, 95% CI = 3.835–76.224) was associated with an increased risk of the combined event, while MFPE (HR = 0.260, 95% CI = 0.078–0.864; p = 0.028) was associated with a reduced risk of the combined event. After the addition of renin-angiotensin system inhibitors (RASi), the incidence of the combined event in the MFPE group (HR = 0.179, 95% CI = 0.047–0.689; p = 0.012) was further reduced.Conclusions NS presented more active lesions and more severe FPE in IgAN. NRP was an independent risk factor for progression to the renal endpoint, while MFPE indicated a better prognosis in NRP without obvious chronic renal lesions, which may benefit from RASi.https://www.tandfonline.com/doi/10.1080/0886022X.2022.2113796IgANnephrotic syndromenephrotic-range proteinuriapodocyte |
| spellingShingle | Yizhen Chen Aicheng Yang Yuansheng Hou Longhui Liu Jiehua Lin Xiaodan Huang Jundu Li Xusheng Liu Fuhua Lu Qizhan Lin Haifeng Yang Shuling Yue Shujun Jiang Lixin Wang Chuan Zou Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role? Renal Failure IgAN nephrotic syndrome nephrotic-range proteinuria podocyte |
| title | Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role? |
| title_full | Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role? |
| title_fullStr | Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role? |
| title_full_unstemmed | Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role? |
| title_short | Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role? |
| title_sort | comparison between outcomes of iga nephropathy with nephrotic range proteinuria and nephrotic syndrome do podocytes play a role |
| topic | IgAN nephrotic syndrome nephrotic-range proteinuria podocyte |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2022.2113796 |
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