Zhi-Yu Duan

Whether IgA nephropathy (IgAN) in patients with systemic lupus erythematosus (SLE) represents a coincidental comorbidity or a distinct clinico-pathological entity remains unclear. This study aimed to characterise the demographic, clinical, pathological, and prognostic features of this rare association. We conducted a systematic review of the PubMed and Embase databases to 31 May 2025 were conducted to identify all reported cases of biopsy-proven IgAN in patients with SLE, excluding cases with concomitant thrombotic microangiopathy, negative Gd-IgA1 immunostaining, prior IgA vasculitis, or ANA-negative disease. Study quality was assessed using the JBI checklist. Individual patient data were pooled; descriptive statistics summarized clinical features, and group comparisons were performed using Mann-Whitney U and Fisher's exact tests. Individual patient data were extracted and analyzed as a single cohort. Renal outcomes were defined as either a ≥ 40% decline in estimated glomerular filtration rate (eGFR) from baseline or progression to end-stage renal disease. Thirty-one patients (25.8% male; mean age 40.8 ± 15.8 years; 67.7% Asian) were included. Median proteinuria was 1.10 g/24 h, and 12.9% presented with nephrotic syndrome. Microscopic haematuria was observed in 93.5% of patients. Mean eGFR at biopsy was 84.0 ± 53.4 mL/min/1.73 m², with 12.9% exhibiting acute kidney injury (AKI). All patients were antinuclear antibody-positive, 64.5% were anti-dsDNA-positive, and 55.2% had hypocomplementaemia. Renal biopsy revealed dominant mesangial IgA and complement C3 deposition, with electron-dense deposits confined to the mesangium in all but one case. Immunosuppression (glucocorticoids 87.1%; cyclophosphamide 22.6%) yielded complete remission in 54.8% of patients. Over a median follow-up of 16.5 months, 27.8% of patients reached the renal endpoint, including three of four patients with AKI. Limited by retrospective case report methodology, this largest cohort to date suggests IgAN complicating SLE manifests a distinctive phenotype that bridges features of primary IgAN and lupus nephritis. Although immunosuppression is effective, long-term renal risk remains non-negligible. Early recognition and targeted therapy may improve outcomes. Not applicable.

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Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide. The clinical spectrum of IgAN varies from minor urinary abnormalities to rapidly progressive renal failure. Evaluation of the disease by repeated renal biopsy is not practical due to its invasive procedure. Urinary sediment miRNAs promise to serve as non-invasive biomarkers to assess kidney injury of IgAN. Fifty two biopsy-proven IgAN patients and twenty five healthy controls were enrolled in the study. Urinary sediment miRNAs were extracted. Expressions of miR-34a, miR-205, miR-21, miR-146a and miR-155 were quantified by real-time quantitative polymerase chain reaction (RT-QPCR). The receiver operating characteristic (ROC) curve was used to investigate the value of the miRNAs for predicting diagnosis of IgAN and evaluating histopathological injury. The patients were treated according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and followed up. The roles of miRNAs in reflecting therapeutic efficacy and disease progression were analyzed. 1. The IgAN group had significantly lower urinary miR-34a, miR-205, and miR-155, but higher miR-21 levels than controls. The ROC revealed that urinary miR-34a ≤ 0.047, miR-205 ≤ 0.209, miR-21 ≥ 0.461 and miR-155 ≤ 0.002 could distinguish patients with IgAN from healthy ones. In addition, miR-205 ≤ 0.125 and miR-21 ≥ 0.891 can distinguish IgAN patients with severe tubular atrophy/interstitial fibrosis from those with mild tubular atrophy/interstitial fibrosis. 2. After a mean 15.19 months follow-up, the reduction of proteinuria (g/24 h/year) was positively correlated with baseline urinary miR-21 and inversely correlated with miR-205. The levels of baseline eGFR and miR-205 in the complete remission group were significantly higher than non-complete remission group (p < 0.001; p = 0.018), while proteinuria, miR-21 and miR-146a were lower than non-complete remission group (p = 0.002; p = 0.021; p = 0.009). But multivariate analysis revealed that only baseline eGFR correlated with the remission of IgAN (p = 0.001, OR = 1.042). The levels of some urinary sediment miRNAs, especially baseline miR-21 and miR-205, may be used as potential prognostic markers for evaluating the tubulointerstitial damage of IgAN. Furthermore, baseline levels of urinary miRNAs may be predictors of therapeutic efficacy and disease progression.