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Abstract: TH-PO427

Pathological Changes After Methylprednisolone (MP) Pulse Therapy in IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1301 Glomerular Diseases: Fibrosis and Extracellular Matrix

Author

  • Cho, Byoung-Soo, Dr. Cho's Kidney Clinic, 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 20-25 years. Lots of therapeutic regimens are tried such as ACEi, ARB, omega-3, corticosteroids, MP pulse therapy and recently many kinds of complement inhibitors, Nefecon, Atacicept, Atrasentan etc., however need a longterm follow up studies to confirm the efficacy.
Up to now most centers regarded proteinuria as a most imporatant prognostic marker in IgA nephropathy. In order to confirm the efficacyof proteinuria as a prognostic marker, we performed follow up renal biopsy who showed normalized proteinuria aDuring last 7 yearsour clinic performed 1,500 cases of renal biopsyfter MP pulse therapy

Methods

During last 7 years our clinic performed 1,500 cases of renal biopsies at OPD level , of which 494 cases (32.9%) were IgA nephropathy patients. We performed follow up renal biopsy in 120 cases who showed normalized urinalysis findings
Renal biopsy findings were divided into 3 groups, Group A: improved pathological findings. Group B : no significant pathologic changes. Group C: aggravated pathological findings such as increased glomerulossclerosis, tubulointerstitial changes, tubular atrophy etc.
One cycle of MP pulse therapy consist of methylprednisolone (20-30mg/kg, max 1gm/day) IV for 3 conscutive days. Depends on pathologic findings we performed 3 to 15 cycles.

Results

Male to female ratio were 59:61, Mean age were 31.1 years old. Of the 120 follow up renal biopsies, 60 cases (50%) showed improved pathological findings (Group A) such as reduced or disappearance of electron dense deposits, restoration of foot processes, decreased mesangial proliferation, 50 cases (40%) showed no significant pathological changes compare to initail pathological findings (Group B), 10 cases (10%) showed aggravated pathological findings such as increased glomerulosclerosis, aggravated intrerstitial fibrosis and tubular atrophy even though clinically improved such as normalized urinalysis findings, stabilized BPand improvement of eGFR. (Group C)

Conclusion

Only 50% of the clinically improved IgA nephropathy patients showed improved pathological findings
Decresed proteinuria could not be a prognostic marker of improvement of IgA nephropathy
Follow up renal biopsy might be mandatory procedure even though clinically improved such as disappearance of proteinuria

Funding

  • Private Foundation Support