title: Reversal of active glomerular lesions after immunosuppressive therapy in patients with IgA nephropathy: a repeat-biopsy based observation.
abstract: BACKGROUND
  Reversal of active glomerular lesions after immunosuppressive treatment in patients with IgA nephropathy (IgAN) and their association with prognosis have not been well established.
  
  
  METHODS
  Sixty patients with IgAN who received repeat biopsies after immunosuppressive treatment were recruited. Reversal of renal pathological lesions was evaluated between the first and second biopsy. The end-point was defined as a 30% reduction in estimated glomerular filtration rate (eGFR) or end-stage renal disease after the second biopsy.
  
  
  RESULTS
  Active glomerular lesions, i.e. endocapillary hypercellularity (E), crescents (C) and necrosis (N) were markedly decreased at the second biopsy after immunosuppressive therapy (36.7 vs. 8.3%, p < 0.001; 85.0 vs. 25.0%, p < 0.001; and 51.7 vs. 3.3%, p < 0.001). Patients with E, C or N at the first biopsy but reversed at the second biopsy showed significantly decreased median levels of proteinuria and hematuria. Such clinical changes were not observed in those with active lesions at both biopsies. After a median follow-up of 32 months, 25.0% of patients reached the end-point. Repeat biopsy confirmed that only tubular atrophy/interstitial fibrosis was associated with the renal outcome.
  
  
  CONCLUSIONS
  Active glomerular lesions can be reversed by immunosuppressive treatment in patients with IgAN. The reversal is accompanied by improvement in proteinuria and hematuria. The reversal of these lesions during the disease process may explain the lack of significant correlation of these lesions with clinical outcomes in the present study as well as in previous evaluation studies of the Oxford classification of IgAN.
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
authors.forename: Xia-Hong
authors.initials: XH
authors.lastname: Shen
authors.forename: Shao-Shan
authors.initials: SS
authors.lastname: Liang
authors.forename: Hui-Mei
authors.initials: HM
authors.lastname: Chen
authors.forename: Wei-Bo
authors.initials: WB
authors.lastname: Le
authors.forename: Song
authors.initials: S
authors.lastname: Jiang
authors.forename: Cai-Hong
authors.initials: CH
authors.lastname: Zeng
authors.forename: Min-Lin
authors.initials: ML
authors.lastname: Zhou
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Zhang
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D007678:Kidney Glomerulus / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents