Diagnostic Value and Clinical Significance of FSGS Subtype in IgA Nephropathy
Focal Segmental Glomerulosclerosis (FSGS) was first described by Fahr in 1925. FSGS is common in pathological changes of IgA Nephropathy (IgAN). IgAN's Oxford study showed that at least one FSGS glomerulus was present in 76% of biopsy specimens. FSGS is one of the independent risk factors for poor prognosis of IgAN.
Oxford studies have shown that FSGS is associated with podocyte damage and changes in glomerular adaptive hemodynamics caused by IgAN. In addition, the Oxford classification of IgAN combined FSGS with balloon adhesion for clinical convenience. The IgAN Oxford Conference in 2014 began to consider whether the FSGS of IgAN should be further subdivided to meet the need to further subdivide the correlation between pathology and clinical manifestations and prognosis.
Shubha et al. further subdivided the pathological changes of FSGS in IgAN patients studied by Oxford, and studied its relationship with clinical manifestations and prognosis. The related results were published in the recent KI journal.
1. Mesangial cell proliferation, endothelial cell proliferation and FSGS or balloon adhesion were independently correlated with patients' proteinuria level during biopsy; Crescent was not an independent predictor of proteinuria in patients.
2. 121 renal biopsy specimens were independently assessed by two pathologists for various FSGS lesions to assess their reproducibility. Periportal sclerosis has excellent repeatability. Apical lesions and hyaline degeneration were well reproducible, podocyte hypertrophy was moderate, and podocyte and endothelial foam cell lesions were poorly reproducible.
3. Apical renal lesions, podocyte hypertrophy, and balloon adhesion were associated with higher levels of proteinuria at renal biopsy. Furthermore, these three factors were independently associated with high levels of proteinuria. There was no significant correlation between renal puncture GFR and mean arterial pressure.
4. Apical lesions, podocyte hypertrophy (no apical lesions), balloon adhesion (no apical lesions and podocyte hypertrophy) and FSGS, hyaline degeneration or podocyte reabsorption granules were not associated with urinary protein levels. Compared with patients with renal pathology S0, apical lesions and podocyte hypertrophy in patients with S1 were associated with proteinuria levels at renal biopsy.
5. Patients with apical lesions and podocyte hypertrophy were followed up for higher urinary protein levels, faster renal function reduction, and higher overall mortality.
6. For young patients with high levels of proteinuria, marked endothelial cell proliferation and mild tubulointerstitial changes suggested by pathology, the immunosuppressive effect was better in patients with apical lesions and podocyte hypertrophy.
This study is the first to further subdivide FSGS in IgAN patients with renal lesions, and to study the prognosis of various FSGS lesions and the response of patients to immunosuppressive therapy. It provides us with clinical reference and pathological basis for immunosuppressive therapy of IgAN. For more information on FSGS and IgAN treatment, please leave a message below or contact online doctor.
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