title: Long-term outcome of IgA nephropathy with minimal change disease: a comparison between patients with and without minimal change disease.
abstract: BACKGROUND
  The clinicopathological characteristics, treatment response and long-term outcome of immunoglobulin (Ig)A nephropathy with minimal change disease (MCD-IgAN) are not well defined.
  
  
  METHODS
  Patients with biopsy-proven MCD-IgAN from the Jinling Hospital IgA nephropathy Registry were systematically reviewed and compared with those with IgA nephropathy without minimal change disease (Non-MCD-IgAN).
  
  
  RESULTS
  We compared data of 247 MCD-IgAN patients and 1,121 Non-MCD-IgAN patients. Compared to Non-MCD-IgAN, MCD-IgAN patients were younger,with male predominance, had higher levels of proteinuria, total cholesterol and estimated glomerular filtration rate (eGFR), lower incidence of hypertension and microhematuria, lower level of serum creatinine, and had less severe glomerular, tubulointerstitial and vascular lesions in renal pathology. In the Non-MCD-IgAN group, 157 patients (14.0 %) reached the renal endpoint and 103 patients (9.2 %) entered end-stage renal disease (ESRD). The 5-,10-, 15- and 20-year cumulative renal survival rates from ESRD, calculated by Kaplan-Meier method, were 95.0, 83.0, 72.9 and 65.4 %, respectively. In the MCD-IgAN group, no patients entered ESRD and only 4 (1.6 %) reached the renal endpoint. Patients with MCD-IgAN had a significantly better renal outcome than Non-MCD-IgAN (p < 0.01). At multivariate Cox analysis, proteinuria >1.0 g/day, hypertension, eGFR <60 ml/min/1.73 m(2), hypoproteinemia and hyperuricemia were independent risk factors of renal survival for Non-MCD-IgAN patients [hazard ratio (HR) 3.43, p < 0.001; HR 1.65, p < 0.05; HR 2.61, p < 0.001; HR 2.40, p < 0.001; HR 2.27, p < 0.001, respectively), but not for patients with MCD-IgAN.
  
  
  CONCLUSIONS
  The long-term outcome of patients with MCD-IgAN is significantly better than that of patients with Non-MCD-IgAN.
authors.affiliation: Department of Nephroloy, Fuyang People's Hospital, 236003, Fuyang, Anhui, China.|National Clinical Research Center of Kidney Diseases, Jinling Hospitial, Nanjing University of Medicine, 210002, Nanjing, Jiangsu, China.
authors.forename: Xiao-Wei
authors.initials: XW
authors.lastname: Li
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospitial, Nanjing University of Medicine, 210002, Nanjing, Jiangsu, China.
authors.forename: Shao-Shan
authors.initials: SS
authors.lastname: Liang
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospitial, Nanjing University of Medicine, 210002, Nanjing, Jiangsu, China.
authors.forename: Wei-Bo
authors.initials: WB
authors.lastname: Le
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospitial, Nanjing University of Medicine, 210002, Nanjing, Jiangsu, China.
authors.forename: Shui-Qin
authors.initials: SQ
authors.lastname: Cheng
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospitial, Nanjing University of Medicine, 210002, Nanjing, Jiangsu, China.
authors.forename: Cai-Hong
authors.initials: CH
authors.lastname: Zeng
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospitial, Nanjing University of Medicine, 210002, Nanjing, Jiangsu, China.
authors.forename: Jin-Quan
authors.initials: JQ
authors.lastname: Wang
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospitial, Nanjing University of Medicine, 210002, Nanjing, Jiangsu, China. liuzhihong@nju.edu.cn.
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Liu
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000150:complications*; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents
keywords: IgA nephropathy; Long-term outcome; Minimal change lesions