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Abstract: TH-PO1013

Influence of Tubular and Interstitial Lesion on Proteinuria Remission and Long-Term Renal Prognosis in IgA Nephropathy with Crescent Lesion Treated with Immunosuppressive Therapy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Fujii, Takayuki, Seirei Sakura Citizen Hospital, Sakura, Japan
  • Suzuki, Satoshi, Seirei Sakura Citizen Hospital, Sakura, Japan
  • Koshizaka, Junya, Seirei Sakura Citizen Hospital, Sakura, Japan
  • Yamauchi, Nobuaki, Seirei Sakura Citizen Hospital, Sakura, Japan
  • Morimoto, Mayu, Seirei Sakura Citizen Hospital, Sakura, Japan
  • Terasaki, Noriko, Seirei Sakura Citizen Hospital, Sakura, Japan
  • Hiroaki, Tanaka, Seirei Sakura Citizen Hospital, Sakura, Japan
Background

Currently, the Oxford classification added crescent (C) score to the conventional mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S), and interstitial fibrosis and tubular atrophy (T) score in IgA nephropathy (IgAN). Although C lesions may be improved with immunosuppressive therapy, renal prognosis with C lesions combined with T lesions remains unclear. We studied proteinuria remission and renal prognosis after steriod therapy in IgAN patients with C lesions in relation to the presence or absence of T lesions.

Methods

This single-center retrospective cohort study included 135 patients with C lesions among 694 patients diagnosed with IgAN and could be followed for ≥1 year or started renal replacement therapy (RRT) within 1 year. Proteinuria remission and renal prognosis (50% decrease in eGFR or initiation of RRT) after steroid therapy were evaluated in relation to the presence of C lesions with and without T lesions (C1T1 and C1T0, respectively). A similar analysis was conducted in a propensity-matched cohort.

Results

There were 101 patients with C1T0 and 34 with C1T1, and 52 patients in C1T0 and 18 in C1T1 were treated with steroid therapy. The mean observation period was 9.2±7.4 years. Age, mean blood pressure, and daily urinary protein excretion were higher and eGFR was lower in C1T1. Compared to supportive care, steroid therapy caused significant proteinuria remission and renal prognosis improvement in C1T0 (log-rank p<0.01). However, in C1T1, steroid therapy achieved significant proteinuria remission (p<0.01), but no renal prognosis improvement effect was seen (p=0.25). In the propensity-matched cohort, significant proteinuria remission (p<0.01) and renal prognosis improvement (p<0.01) were achieved by steroid therapy in C1T0. In C1T1, although proteinuria remission rate at 2 years was higher in those given steroid therapy than those not given (57% vs 29%, p=0.27), there was no significant difference in renal prognosis between the two groups (p=0.46).

Conclusion

In IgAN patients with C lesions, proteinuria remission is achieved by steroid therapy. However, when there are concomitant T lesions, the effect of steroid therapy in improving renal prognosis is limited.