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Kidney Week

Abstract: FR-PO878

Follow-Up Kidney Biopsy Might Be a Mandatory Procedure after Treatment in IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • Cho, Byoung-Soo, Dr.Cho’s Kidney Clinic, Seoul, Korea (the Republic of)
  • Cho, Won-Hee, Sahm-Yook General Hospital, Seoul, Korea (the Republic of)
Background

IgA nephropathy is one of the most common chronic glomerulonephritis and 30-45% fall into CKD over a period of 20 to 25 years.
Lots of therapeutic regimens have been tried such as ARB,ACEi,omega-3, corticosteroids, endothelin inhibitors, Nefecon, complement inhibitors[K1] , finerenone, methylprednisolone pulse, SGLT2 inhibitor etc, however need a longterm follow up studies to confirm the efficacy.
Disappearance of proteinuria has long been regarded as surrogate marker of treatment effect, however we have reported that disappearance of proteinuria could not be a surrogate marker after treatment (2022 ASN) At this time we compare the pathological changes who showed clinically improved by methylprednisolone pulse therapy in IgAN.

Methods

During last 10 years our clinic performed 1,982 cases of renal biopsy were done, of which 619 cases (31.2%) were IgAN. We performed follow up renal biopsies in 160 cases (25.8%), who showed clinical improvement include normalized urinalysis findings.
Follow up renal biopsy findings were divided into 3 groups : group A: improved renal pathology, group B: no significant pathological changes and group C: aggravated pathological finding
One cycle of MP pulse therapy consists of MP (20-30mg/kg,, max 1gm/day) IV for 3 consecutive days. Depends on the severity, we performed 3-17 cycles every 2 weeks

Results

Male to female ratio were 81:79, Mean ages were 33 years old. Of the 169 follow up cases 83 (51.9%) showed improved pathologically (Group A) such as disappearance of electron dense deposits, restoration of foot processes, decreased mesangial proliferation, 63 cases (39.3%) showed no significant changes (Group B) and 14 cases (8.8%) showed aggravated pathological changes such as increased glomerulosclerosis, tubular atrophy and interstitial fibrosis

Conclusion

Among the 160 cases of clinically improved cases, only 83 (51.9 %) were pathologically improved,
Normalized urinary findings could not be a prognostic marker of improved pathology and so group B & C patients need a careful follow up
Follow up renal biopsy might be a mandatory procedure to define the efficacy of treatment in IgA nephropathy