#1368 Podocytopathy associated with IgA nephropathy: is it really a prognostic factor?

Abstract

Abstract Background and Aims Since 2017, the clinical value of podocyte injury in IgA nephropathy (IgAN) has been studied, the presence of podocyte hypertrophy and tip- lesions are markers of podocyte damage. It has been observed that these histological findings tend to be treated with immunosuppression, so they have a better kidney prognosis, but those who do not receive immunosuppression have a worse prognosis. In Latin America there are no cohorts that evaluate the clinical course of these lesions. Method Cases and control. Results A total of 37 patients with a diagnosis of IgAN were evaluated, of these 27% presented podocytopathy (IgAN-P) and 72.9% presented IgAN without histological data in the optical microscopy of podocytopathy (IgAN-NP), with an average follow-up of 41 ± 32 months. Clinically, the proteinuria in IgAN-P patients was higher with a mean of 3.9 ± 3.0 gr/gr vs 1.6 ± 1.5 gr/gr in the group with IgAN-NP, without being statistically significant p = 0.54. Kidney function in the group with podocytopathy was slightly lower with an average eGFR of 65.9 ± 45 ml/min/1.73 m2 vs 80.2 ± 36.4 ml/min/1.73 m2 p = 0.23, associated with a greater presence of granular casts in podocytopathy (92% vs 80% p = 0.02) describing probable associated acute tubular injury. Histologically, patients with podocytopathy presented 80% of podocyte hypertrophy and 2% of tip-type FSGS. The findings in the MEST-C score had no differences between the groups, except for mesangial proliferation that was present in 96.3% of subjects with podocytopathy compared to 70% of subjects without podocytopathy, p = 0.02. The prognosis based on the international score was not statistically significant between the groups p = 0.59. Patients with podocytopathy tended to be treated with immunosuppression prior to the biopsy in 50% vs 37% in the group without podocytopathy p = 0.01, however once the histological diagnosis was obtained it was more common to decide to continue with immunosuppressants in subjects with podocytopathy with 90% vs 63% (p = 0.11). Finally, long-term results reported no differences in the requirement for kidney replacement therapy. When evaluating MAKE outcomes, there were no differences between groups with respect to ESKD; 40% decrease in eGFR and need for kidney replacement therapy. Conclusion In previous reports the presence of podocytopathy reported as podocyte hypertrophy and tip-lesions were 16%. In our population this finding was more frequent (27%), with podocyte hypertrophy being more prevalent. Greater proteinuria and worse kidney function were observed compared to IgAN-NP, justifying a greater frequency of immunosuppressive therapy, impacting the kidney outcome being the same as that reported in patients without podocytopathy. Similar result to that observed in previous cohorts.