{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T02:45:45Z","timestamp":1776048345515,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004413","name":"T\u00fcrk Nefroloji Dernegi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004413","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>There is still a lack of consensus regarding the best treatment approach for IgA nephropathy (IgAN). We investigated the outcomes of immunosuppressive therapies (IST) used in IgAN patients with different clinical presentations, using nationwide data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We carried out a retrospective cohort study, utilising data from the database of the TSN\u2010GOLD Working Group. Our study encompassed patients with at least 6 months of follow\u2010up. Data were gathered on various aspects of patients including demographic characteristics, clinical presentation, laboratory test results, and treatment regimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 1281 IgAN patients registered in the database, 913 patients who fulfilled the study criteria were included in the study. A total of 313 patients were classified into the asymptomatic urinary abnormality (AUA) group, 368 patients were classified into the nephritic syndrome group, and 232 patients were classified into the nephrotic syndrome group. AUA group had significantly the lowest rate of IST use (38.3%) compared to the nephritic syndrome group (55.2%) and the nephrotic syndrome group (65.1%). The most used IST was steroid therapy (46.2%), followed by mycophenolic acid derivatives (7.3%), azathioprine (6.4%), cyclophosphamide (5.1%), and calcineurin inhibitors (4.3%). The median follow\u2010up period of the patients was 40 (24\u201383) months. Remission was generally achieved in the first 3 months after the biopsy. The highest remission rate among all patients was observed in the patient group with AUA (84.5%), while it was 76.8% in nephritic syndrome and 77.3% in nephrotic syndrome. The primary outcome was defined as a decline in eGFR of \u2265\u200950% from baseline or the development of ESRD during follow\u2010up. The median duration to reach the primary outcome was 120 months in the AUA group, 108 months for nephritic syndrome group, and 84 months for nephrotic syndrome group. The mean duration to reach the primary outcome for both nephritic and nephrotic groups was significantly shorter than that of the AUA group (Log Rank\n                      <jats:italic>p<\/jats:italic>\n                      : 0.044 and 0.002, respectively). In multivariate analysis regarding the factors related to the primary outcome, both nephritic syndrome were significantly associated with an increased risk compared to AUA [Hazard ratio (HR): 1.563, 95% confidence interval (CI): 1.049\u20132.328,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028 and HR: 1.915, CI:1.237\u20132.964,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004, respectively]. IST was associated with a reduced risk (HR\u2009=\u20090.699, 95% CI\u2009=\u20090.503\u20130.971,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IST affects IgAN phenotypes differently: AUA patients, with minimal IST, achieved the highest remission and longest time to renal decline, while nephritic and nephrotic groups, receiving more IST, progressed faster. These findings advocate phenotype\u2010tailored IST and long\u2010term follow\u2010up, and highlight the need for MEST\u2010C in future studies to standardise risk assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nep.70193","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T10:23:07Z","timestamp":1773915787000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Optimal Management Strategy for IGA Nephropathy Patients With Different Clinical Presentations"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0961-3810","authenticated-orcid":false,"given":"Savas","family":"Ozturk","sequence":"first","affiliation":[{"name":"Istanbul Faculty of Medicine, Department of Nephrology Istanbul University  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Sumnu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Clinic of Nephrology Medipol Mega Hospital, Medipol University  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Necmi","family":"Eren","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Kocaeli University  Kocaeli T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mevlut Tamer","family":"Dincer","sequence":"additional","affiliation":[{"name":"Cerrahpasa Faculty of Medicine, Department of Nephrology Istanbul University  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sami","family":"Uzun","sequence":"additional","affiliation":[{"name":"Clinic of Nephrology Haseki Training and Research Hospital, University of Health Sciences  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vafa","family":"Suleymanova","sequence":"additional","affiliation":[{"name":"Istanbul Faculty of Medicine, Department of Nephrology Istanbul University  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet Deniz","family":"Ayli","sequence":"additional","affiliation":[{"name":"Clinic of Nephrology Ankara Etlik City Hospital, University of Health Sciences  Ankara T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gulizar","family":"Sahin","sequence":"additional","affiliation":[{"name":"Clinic of Nephrology Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulver","family":"Derici","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Gazi University  Ankara T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taner","family":"Basturk","sequence":"additional","affiliation":[{"name":"Nephrology Clinic Hamidiye Etfal Training and Research Hospital, University of Health Sciences  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamad","family":"Dheir","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Sakarya University  Sakarya T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenan","family":"Turgutalp","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Training and Research Hospital, Mersin University  Mersin T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murvet","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Clinic of Nephrology Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezgi Coskun","family":"Yenigun","sequence":"additional","affiliation":[{"name":"Clinic of Nephrology Ankara Bilkent City Hospital, University of Health Sciences  Ankara T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramazan","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Clinic of Nephrology Ankara Training and Research Hospital, University of Health Sciences  Ankara T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erhan","family":"Tatar","sequence":"additional","affiliation":[{"name":"Izmir Faculty of Medicine, Department of Nephrology Bozyaka Training and Research Hospital, University of Health Sciences  Izmir T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meltem","family":"Gursu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Bezmialem Vakif University  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Onur","family":"Tunca","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Nephrology Afyonkarahisar Health Science University  Afyon T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0342-9692","authenticated-orcid":false,"given":"Aysegul","family":"Oruc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Bursa Uludag University  Bursa T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zulfikar","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Dicle University  Diyarbakir T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeki","family":"Aydin","sequence":"additional","affiliation":[{"name":"Nephrology Darica Farabi Training and Research Hospital, University of Health Sciences  Kocaeli T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sedat","family":"Ustundag","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Trakya University  Edirne T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kultigin","family":"Turkmen","sequence":"additional","affiliation":[{"name":"Meram Faculty of Medicine, Department of Nephrology Necmettin Erbakan University  Konya T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6385-2129","authenticated-orcid":false,"given":"Sim","family":"Kutlay","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Ankara University  Ankara T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebnem","family":"Karakan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Nephrology Yildirim Beyazit University  Ankara T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melike Betul","family":"Ogutmen","sequence":"additional","affiliation":[{"name":"Department of Nephrology Haydarpasa Numune Training and Research Hospital, University of Health Sciences  Istanbul T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seda Safak","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Istanbul Faculty of Medicine, 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