A new study from the First Affiliated Hospital of Sun Yat-sen University has provided important insights about the clinical features and long-term prognosis of patients with IgA nephropathy (IgAN) complicated by nephrotic syndrome (NS). Nephrotic syndrome, which occurs in 5-15% of patients with IgAN, poses significant risks, leading to worse renal outcomes compared to those without this complication.
The research aimed to explore the clinical-pathological characteristics of patients diagnosed with NS-IgAN from January 2001 to November 2021. These patients were divided based on their pathological features: IgAN with mesangial proliferative glomerulonephritis (IgAN-MsPGN), IgAN with minimal change disease (IgAN-MCD), IgAN with membranous nephropathy (IgAN-MN), and IgAN with membranoproliferative glomerulonephritis (IgAN-MPGN).
Out of 207 NS-IgAN patients included, findings revealed significant variances among different pathological groups. The IgAN-MCD group, interestingly, exhibited the best renal prognosis and had higher rates of proteinuria remission compared to IgAN-MsPGN patients. While the majority of patients were identified as having IgAN-MsPGN, their outcomes were markedly inferior, manifesting lower rates of sustained improvement.
The mean age for NS-IgAN patients was approximately 31 years, with males constituting over half of the study group. Various clinical details, including serum albumin and creatinine levels, blood pressure, and the incidence of hematuria, were documented, showing distinct patterns among the pathological subtypes. For example, those with IgAN-MCD were younger and presented with less severe symptoms.
Follow-up assessments revealed alarming statistics: 27.8% of patients reached renal endpoints, underscoring the severity of the disease. The study suggests addressing and identifying the correct renal pathology through biopsy plays a pivotal role for effective treatment and prognostic capabilities. Treatment methods included supportive care such as angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs), with cases receiving oral corticosteroid therapy or immunosuppressive treatments, depending on the pathological classification.
The findings also stressed the importance of immediate intervention for patients presenting with nephrotic syndrome. Researchers highlighted, "Accurate renal pathology identification via biopsy in NS-IgAN patients is pivotal for directing treatment and predicting prognosis." This echoes the pressing need for targeted strategies to handle underlying conditions contributing to nephrotic syndrome.
Patients exhibiting minimal change disease-like features responded significantly well to corticosteroid therapy, achieving remission rates of nearly 95%. This is indicative of the potential for misdiagnosis, as similar lesions may occur with various other conditions leading to different therapeutic protocols.
Overall, the study concludes there are substantial differences between clinical presentation and long-term prognosis based on the specific pathological-type of IgAN. This new classification could be invaluable for guiding therapeutic decisions moving forward. Future research is warranted to corroborate these findings on broader populations and to develop effective management strategies for this high-risk patient subgroup.
By establishing clearer guidelines for the diagnosis and management of NS-IgAN, healthcare professionals may mitigate the dire consequences typically observed with nephrotic syndrome and improve life quality for affected individuals.