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Dioscin Mediated IgA Nephropathy Alleviation by Inhibiting B Cell Activation In Vivo and Decreasing Galactose-Deficient IgA1 Production In Vitro
Published on: October 13, 2023
Anti-CD20 Therapies and Antinephrin Autoantibodies in IgA Nephropathy With Minimal Change Disease
Yu Liang1, Zerui Yang1, Xiaohan Yuan1,2
1Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Introduction:
In IgA nephropathy (IgAN) with minimal change disease (MCD) (MCD-IgAN), the efficacy of anti-CD20 monoclonal antibodies (mAbs) and the profile of antinephrin antibodies remain poorly understood.
Methods:
We evaluated the efficacy of anti-CD20 mAbs or combined short-course low-dose steroids (anti-CD20 mAbs group) compared with full-dose prolonged steroids (steroids group) and assessed the prevalence of antinephrin antibodies in a retrospective cohort of patients with MCD-IgAN.
Results:
Total remission rates of nephrotic syndrome were comparable between the anti-CD20 mAbs group and the steroids group in 45 adult patients with MCD-IgAN. Notably, the anti-CD20 mAbs group achieved a longer recurrence-free period after complete remission than the steroids group (median 30.4 vs. 17.1 months, P = 0.01). In addition, patients in the anti-CD20 mAbs group experienced significantly fewer total adverse events and rehospitalization rates. Circulating antinephrin antibodies was detected in 31.1% (19/61) of patients with MCD-IgAN, comparable to patients with MCD. Furthermore, patients with antinephrin antibodies > 150 ng/ml exhibited significantly increased hazard risk of recurrence (hazard ratio = 3.93, 95% confidence interval [CI]: 1.18-13.13), higher recurrence rate per person-year (incidence rate ratio: 3.16, 95% CI: 1.42-7.03) and shorter relapse-free interval than those with lower antinephrin antibodies (median 14.0 vs. 48.3 months, P = 0.02). Importantly, antinephrin antibody levels in sequential plasma samples closely tracked clinical course of disease remission and relapses during follow-up.
Conclusion:
Our findings indicate that anti-CD20 mAbs represent an effective and safe therapeutic option for adult patients with MCD-IgAN. Circulating antinephrin antibodies were detectable and associated with a higher relapse rate, suggesting its potential utility as a biomarker of both disease activity and therapeutic target in this disease.
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