Abstract
Background: IgA nephropathy (IgAN) has a high degree of heterogeneity in clinical and pathological features. Among all subsets of IgAN, the pathogenesis of IgAN with minimal change disease (MCD-IgAN) remained controversial. Methods: We analyzed the clinical and pathological characteristics of MCD-IgAN patients in a retrospective cohort. Patients diagnosed with IgAN, excluding MCD-IgAN, were randomly selected as controls. Levels of plasma galactose-deficient IgA1 (GdIgA1), IgG autoantibodies against GdIgA1, GdIgA1 deposition in the glomerulus, and inflammatory reactivity of circulating poly-IgA1 complexes to cultured mesangial cells were evaluated. Results: Patients with MCD-IgAN had significantly higher levels of proteinuria and estimated glomerular filtration rate (eGFR), lower levels of albumin and urine blood cells, and milder histological lesions by a light microscope compared to IgAN patients, which bears a resemblance to MCD. Lower levels of GdIgA1 (3.41 ± 1.68 vs. 4.92 ± 2.30 μg/ml, p = 0.009) and IgG antiglycan autoantibodies (23.25 ± 22.59 vs. 76.58 ± 71.22 IU/ml, p < 0.001) were found in MCD-IgAN patients than those in IgAN controls. Meanwhile, weaker fluorescence intensities of both IgA and GdIgA1 were observed in the glomerulus of MCD-IgAN patients compared to those in IgAN patients. Furthermore, poly-IgA1 complexes from MCD-IgAN patients induced weaker inflammatory effects on cultured mesangial cells than those from IgAN patients in vitro. Conclusion: The results demonstrated that MCD-IgAN cases represent a dual glomerulopathy, namely, mild IgAN with superimposed MCD, which furthermore provides substantial evidence for the corticosteroids therapy in MCD-IgAN patients as the guidelines recommended.
Highlights
IgA nephropathy (IgAN) is one of the most common glomerulonephritis worldwide, especially in Asia (Wyatt and Julian, 2013)
A total of 27 minimal change disease (MCD)-IgAN patients with a mean age of 30.6 ± 12.1 years old were enrolled in this study
All MCD-IgAN patients have initially received corticosteroids, of which 12 cases were treated in combination with other immunosuppressants
Summary
IgA nephropathy (IgAN) is one of the most common glomerulonephritis worldwide, especially in Asia (Wyatt and Julian, 2013). Among all subsets of IgAN, cases presenting nephrotic syndrome (NS) and mild mesangial proliferation are rare, accounting for approximately 5%–10% of all IgAN patients (Barratt and Feehally, 2006; Kim et al, 2012). This variant form of IgAN with clinical NS presentation and electron microscope (EM) features of diffuse foot process effacement resembling minimal change disease (MCD) is defined as MCD-IgAN (Floege et al, 2019). Among all subsets of IgAN, the pathogenesis of IgAN with minimal change disease (MCD-IgAN) remained controversial
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
