The effect of immunosuppressive therapy in patients with fibrinoid necrosis lesions in a large cohort of patients with IgA nephropathy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2021-10-21

AUTHORS

Yingman Guo, Sufang Shi, Xujie Zhou, Lijun Liu, Jicheng Lv, Li Zhu, Suxia Wang, Hong Zhang

ABSTRACT

BackgroundFibrinoid necrosis is considered one of the active pathological lesions in IgA nephropathy. Whether patients with IgA nephropathy with fibrinoid necrosis lesions benefit from immunosuppressive therapy in terms of long-term outcomes remains uncertain. This study aimed to evaluate the response to immunosuppressive therapy in patients with fibrinoid necrosis lesions in a large cohort of patients with IgA nephropathy.MethodsA total of 1325 patients with kidney biopsy-proven IgA nephropathy from 1994 to 2016 were recruited from the Peking University First Hospital IgA Nephropathy Database. The clinicopathological characteristics of patients with fibrinoid necrosis lesions and the effect of immunosuppressive therapy on patients with fibrinoid necrosis lesions alone or in those with fibrinoid necrosis together with crescents or endocapillary hypercellularity lesions were analyzed.ResultsIn total, 107/1325 (8.1%) patients showed fibrinoid necrosis lesions, and 92/107 (86.0%) of these patients showed fibrinoid necrosis associated either with cellular/fibrocellular crescents or endocapillary hypercellularity lesions. The presence of fibrinoid necrosis together with crescents or endocapillary hypercellularity was an independent risk factor for the kidney composite endpoint (HR, 2.11; 95% CI, 1.16–3.84; P = 0.02) in patients without immunosuppression, while for those receiving immunosuppressive therapy, kidney outcome was improved (HR, 0.80; 95% CI, 0.46–1.39; P = 0.42). However, the predictive value of fibrinoid necrosis lesions alone did not change significantly between patients with and without immunosuppressive therapy.ConclusionsThe presence of fibrinoid necrosis with crescents or endocapillary hypercellularity lesions together, but not fibrinoid necrosis lesions alone, was a pathological indicator of patients who may benefit from immunosuppressive therapy.Graphical Abstract More... »

PAGES

1-11

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s40620-021-01176-x

DOI

http://dx.doi.org/10.1007/s40620-021-01176-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1142050814

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/34676523


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