Severe foot process effacement tied to renal failure in 1,506 IgA nephropathy patients

A retrospective study published in BMC Nephrology examined 1,506 patients with biopsy-proven IgA nephropathy (IgAN). It assessed how the severity of foot process effacement (FPE) relates to prognosis and to response to treatment biomedcentral.comBMC Nephrologybiomedcentral.comOpen source ↗. Patients were divided into three groups by degree of FPE and followed for at least 12 months.

The authors used Kaplan-Meier survival analysis and Cox regression to explore the link between FPE and adverse renal outcomes. To evaluate the prognostic model they used the concordance index (C-index), the area under the ROC curve (AUC) and a calibration curve.

Prognosis and risk model

Patients in the severe FPE group had more severe clinical and pathological manifestations than the other groups. Kaplan-Meier analysis showed a significantly higher risk of renal failure in this group (log-rank P < 0.01).

Multivariate Cox regression indicated that FPE may be an independent risk factor for renal prognosis in IgAN (adjusted HR 3.688, 95% CI 1.548-8.784, P = 0.009) biomedcentral.comBMC Nephrologybiomedcentral.comOpen source ↗. Subgroup analysis suggested that the FPE level deserves particular attention in male patients aged 45 years or younger.

The researchers also built a nomogram that includes FPE to estimate the risk of end-stage renal disease (ESRD) at 3, 5 and 8 years. Its C-index was 0.93, and the AUCs were 0.958, 0.964 and 0.892 for the three time points. The authors report that the model was well calibrated.

Treatment response

The study found that FPE severity is an important factor influencing response to treatment, and that immunosuppressive therapy (IST) can overcome this influence. For patients with severe FPE, the authors describe IST as an essential intervention and recommend a treatment duration of no less than 12 months.

The authors conclude that FPE serves as an independent predictor of renal progression in IgAN and has significant clinical value biomedcentral.comBMC Nephrologybiomedcentral.comOpen source ↗. The findings come from a retrospective cohort and are reported as associations with renal outcomes.