Cheng-Wen Yang1,2, Fan-Yu Chen2,3, Fu-Pang Chang3,4, Yang Ho2,3, Bo-Sheng Wu3, An-Hang Yang3,4,5, Der-Cherng Tarng2,3,5,6,7, Chih-Yu Yang8,9,10,11,12. 1. Division of Nephrology, Department of Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan. 2. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan. 3. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 4. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan. 5. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 6. Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan. 7. Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan. 8. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan. cyyang3@vghtpe.gov.tw. 9. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. cyyang3@vghtpe.gov.tw. 10. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. cyyang3@vghtpe.gov.tw. 11. Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan. cyyang3@vghtpe.gov.tw. 12. Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan. cyyang3@vghtpe.gov.tw.
Abstract
BACKGROUND: Immunoglobulin M (IgM) mesangial deposition in pediatric minimal change disease (MCD) has been reported to be associated with steroid dependence and poor renal outcomes. However, the evidence linking the impacts of IgM mesangial deposition to the treatment prognosis in adult-onset MCD is still elusive. METHODS: In this retrospective cohort study, 37 adult patients with MCD received kidney biopsies from January 2010 to May 2020. Immunofluorescence microscopy was performed and the patients dichotomized according to IgM mesangial deposition (12 patients with positive IgM deposition; 25 patients with negative IgM deposition). We analyzed the clinical features, the dosage of immunosuppressive agents, and the response to treatment for 2 years between the two groups. RESULTS: Analysis of the clinical symptoms, the dosage of immunosuppressive treatment, and the time to remission revealed no statistical difference between the groups. However, compared to the negative IgM group, the frequency of relapses was significantly higher in the positive IgM group during the two-year follow-up period (the negative IgM group 0.25 episodes/year; the positive IgM group 0.75 episodes/year, p = 0.029). Furthermore, multivariate linear regression revealed that the positivity of IgM mesangial deposition is independently associated with the frequency of relapses (regression coefficient B 0.450, 95% CI 0.116-0.784, p = 0.010). CONCLUSIONS: Our findings indicated that adult-onset MCD patients with IgM mesangial deposition have a high risk of relapses. Therefore, intensive monitoring of disease activity should be considered in MCD adults with IgM mesangial deposition.
BACKGROUND: Immunoglobulin M (IgM) mesangial deposition in pediatric minimal change disease (MCD) has been reported to be associated with steroid dependence and poor renal outcomes. However, the evidence linking the impacts of IgM mesangial deposition to the treatment prognosis in adult-onset MCD is still elusive. METHODS: In this retrospective cohort study, 37 adult patients with MCD received kidney biopsies from January 2010 to May 2020. Immunofluorescence microscopy was performed and the patients dichotomized according to IgM mesangial deposition (12 patients with positive IgM deposition; 25 patients with negative IgM deposition). We analyzed the clinical features, the dosage of immunosuppressive agents, and the response to treatment for 2 years between the two groups. RESULTS: Analysis of the clinical symptoms, the dosage of immunosuppressive treatment, and the time to remission revealed no statistical difference between the groups. However, compared to the negative IgM group, the frequency of relapses was significantly higher in the positive IgM group during the two-year follow-up period (the negative IgM group 0.25 episodes/year; the positive IgM group 0.75 episodes/year, p = 0.029). Furthermore, multivariate linear regression revealed that the positivity of IgM mesangial deposition is independently associated with the frequency of relapses (regression coefficient B 0.450, 95% CI 0.116-0.784, p = 0.010). CONCLUSIONS: Our findings indicated that adult-onset MCD patients with IgM mesangial deposition have a high risk of relapses. Therefore, intensive monitoring of disease activity should be considered in MCD adults with IgM mesangial deposition.