title: Clinicopathologic features and treatment response in nephrotic IgA nephropathy with minimal change disease.
abstract: OBJECTIVE
  To analyze the clinicopathological features and therapeutic response of nephrotic IgA nephropathy (IgAN) patients with minimal-change disease (MCD).
  
  
  METHODS
  62 nephrotic IgAN patients were enrolled between January 2002 and December 2008, and divided into two groups including Group A: patients with MCD-like pathological features, and Group B with non-MCD pathologic pattern. The clinicopathological features, treatments, and responses were then analyzed.
  
  
  RESULTS
  13 (21.0%) patients exhibited MCD-like pathological changes. Patients in Group A presented more prominent proteinuria, hypoalbuminemia but higher hemoglobin and no incidence of renal insufficiency compared to Group B (p < 0.05). 62 patients were treated with corticosteroid, and the complete remission rate in Group A is higher than that in Group B (84.6% vs. 34.7%, p = 0.008), but the relapse rate is much higher in Group A (53.8% vs. 20.4%, p = 0.03). 21 patients were treated combining with immunosuppressant due to unresponsiveness or relapse, which yielded a high re-remission rate in Group A (100%). After follow-up of 53.9 ± 26.9 months, the 5-year renal survival rate is higher in Group A (100%) than that in Group B (84.7%), but no significant difference was observed (p = 0.24).
  
  
  CONCLUSIONS
  MCD-like pathological changes exist in quite a few nephrotic IgAN patients. These IgAN patients responded well to corticosteroid monotherapy but had a higher rate of relapse. Though manifesting with severe nephrotic symptoms, they tended to have a favorable clinical outcome probably due to the minimal pathological changes. Nevertheless, larger sample size and longer follow-up periods are needed for better understanding of the disease.
authors.affiliation: Department of Nephrology, Sun Yat-sen University, Guangzhou, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Qin
authors.forename: Qiongqiong
authors.initials: Q
authors.lastname: Yang
authors.forename: Xueqing
authors.initials: X
authors.lastname: Tang
authors.forename: Wenfang
authors.initials: W
authors.lastname: Chen
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Li
authors.forename: Haiping
authors.initials: H
authors.lastname: Mao
authors.forename: Zongpei
authors.initials: Z
authors.lastname: Jiang
authors.forename: Fengxian
authors.initials: F
authors.lastname: Huang
authors.forename: Xueqing
authors.initials: X
authors.lastname: Yu
mesh_terms: D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000188:drug therapy / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007678:Kidney Glomerulus / Q000648:ultrastructure*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000188:drug therapy / Q000473:pathology*; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000473:pathology*; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents