Management and Clinical Outcomes of Membranous Nephropathy, IgA Nephropathy, and Minimal Change Disease Two Years Post-Kidney Biopsy

Abstract

<b><i>Introduction:</i></b> This study evaluated the phenotypic and pathology characteristics of patients undergoing kidney biopsy at a single center, while also determining the frequency and factors associated with clinical outcomes. <b><i>Methods:</i></b> The incidence and distribution of biopsy-proven kidney diseases in 2000–2019 were surveyed. Consecutive individuals diagnosed with membranous nephropathy (MN), immunoglobulin A nephropathy (IgAN), and minimal change disease (MCD) between August 2015 and December 2019 were enrolled in the prospective 2-year follow-up study. Outcomes included remission of proteinuria and kidney disease progression events. Multivariable-adjusted Cox proportional hazards model was applied. <b><i>Results:</i></b> 4,550 kidney biopsies were performed in 2000–2019, showing a noticeable increase in the proportion of MN. 426 patients were enrolled in the follow-up cohort. 346 (81.2%) achieved remission of proteinuria, 39 (9.2%) suffered kidney disease progression and 51.3% of them were diagnosed with IgAN. Kidney pathological diagnosis (MN vs. MCD: hazard ratio [HR], 0.42; 95% confidence interval [95% CI], 0.31–0.57; IgAN vs. MCD: 0.58; 0.39–0.85), levels of 24-h urine protein at biopsy (1.04; 1.00–1.08) and presence of nodular mesangial sclerosis (0.70; 0.49–0.99) were significantly correlated with remission of proteinuria after adjusting for baseline variables. 24-h urine protein levels at biopsy (1.14; 1.04–1.25) and the presence of crescents (2.30; 1.06–4.95) were the independent risk factors for kidney disease progression events after adjusting for baseline variables. <b><i>Conclusion:</i></b> The increasing frequency of MN has been affirmed over the past 2 decades. The therapeutic status, clinical outcomes, and factors influencing these outcomes were presented in this single-center study for the three primary glomerular diseases.