#1535 Prognostic indicators after treatment in IgA nephropathy

Abstract Background and Aims IgA nephropathy is one of the most common chronic glomerulonephritis and 30%–45% fall into CKD over a period of 20 to 25 years. Lots of therapeutic regimens are tried such as corticosteroids, ARB/ACEi, endothelin inhibitors, complement inhibitors, Anti-APRIL/BAF, SGLT2 inhibitors etc., however there is no cure as yet.(2024,ASN). Decreased proteinuria have long been regarded as surrogate marker of therapeutic effects, however our group showed even without proteinuria, pathologically improved cases were only 50% (2024,ASN). In order to find out the prognostic indicator we performed follow up biopsy after treatment and compare the urinary findings and pathologic findings Method From 2013 to 2019, 256 cases of IgA nephropathy were diagnosed as IgA nephropathy at our clinic. 246 cases took methylprednisolone (MP) pulse therapy, of which 104 cases who showed clinical improvement took follow up renal biopsy. Follow up renal biopsy findings were divided into 3 groups: group A: treated IgA nephropathy (no EDD, restoration of foot process). Group B: improved renal pathology (decreased amount of EDD, disappearance of crescents, restored epithelial foot processes etc.), group C: no significant pathological changes. One cycle of MP consists of MP (20-30 mg/kg, max 1 gm/day) for 3 consecutive days, depends on renal pathology by Lee's classification. We performed 3 to 17 cycles every 2 weeks. Results Male to female ratio were 52:52. Mean ages were 31.4 years old. Of the 246 cases who took MP pulse therapies 104 cases were performed follow up renal biopsy were performed who showed improved urinary findings. Follow up renal biopsy results were as follows: Group A were 35 cases, Group B 48 cases and Group C 21 cases. No patients relapsed during 8.4 years follow up in group A & B, however 2 cases were relapsed in group C. Conclusion In addition to clinical findings disappearance of EDD, disappearance of crescents, restoration of epithelial foot process should be regarded as cure in IgA nephropathy. In group B and C: close monitoring at least every 3 months is mandatory to check relapse. Follow up renal biopsy might be a mandatory procedure to confirm the treatment effects in IgA nephropathy.