Kidney Res Clin Pract.  2020 Sep;39(3):295-304. 10.23876/j.krcp.20.017.

Severity of foot process effacement is associated with proteinuria in patients with IgA nephropathy

Affiliations
  • 1Department of Pathology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
  • 2Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
  • 3Department of Biostatistics, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
  • 4Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
  • 5Soonchunhyang Institute of Medi-bio Science, Soonchunhyang University, Cheonan, Republic of Korea

Abstract

Background
Proteinuria is a significant risk factor for progression of IgA nephropathy (IgAN) and has a positive correlation with severity of foot process effacement (FPE). We evaluated the relationship of FPE with proteinuria and histologic characteristics, including the Oxford classification.
Methods
Patients who underwent renal biopsy and were diagnosed with IgAN at a single center were retrospectively reviewed. Patients aged less than 18 years and those with the possibility of secondary causes were excluded from the study. Subsequently, we evaluated the association between degree of proteinuria, severity of FPE, and histologic characteristics, including the Oxford classification and other immunofluorescence stains.
Results
A total of 805 cases of renal biopsy was performed at our institution, and 327 patients were diagnosed with IgAN. Among them, 82 patients were excluded. Severity of FPE had an impact on the degree of proteinuria. Notably, the group with diffuse FPE had more than about 1.3 g/day of urine protein compared to those with rare FPE. Among the histologic characteristics, M1 score and immune deposition of IgG affected severity of FPE (hazard ratios [95% confidence interval], 1.90 [1.10 to 3.26], and 3.77 [1.66 to 8.54], respectively).
Conclusion
Severity of FPE had an impact on the degree of proteinuria and may be associated with the pathogenesis of IgAN.

Keyword

Glomerulonephritis; Immunoglobulin A; Nephropathy; Podocytes; Proteinuria
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