{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:15:35Z","timestamp":1788419735352,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Targeted-release (TR) budesonide provides upstream mucosal immunomodulation in IgA nephropathy (IgAN) by targeting the gut-associated lymphoid tissue. However, the extent to which distinct downstream immune-inflammatory phenotypes and established structural chronicity shape real-world remission trajectories remains insufficiently characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 57 adults with biopsy-proven primary IgAN treated with TR-budesonide. Prespecified milestones were Very Early Response (VER) at 3 months, Early Response (ER) at 6 months, and composite clinical remission (complete or partial remission, CR\/PR) over 12 months. We constructed a time-dependent prognostic nomogram using multivariable Cox modeling integrating the full Oxford MEST-C spectrum and concurrent therapies, strictly applying optimism-corrected bootstrapping (1,000 iterations) to ensure robust internal validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Relative proteinuria reductions were broadly comparable across MEST-C strata, even among patients with substantial baseline chronicity (S1, 91.2%; T1\/T2, 63.2%). Concomitant sodium\u2013glucose cotransporter 2 inhibitor (SGLT2i) therapy independently predicted VER (OR 9.40, 95% CI 1.36\u201364.92; P\u00a0=\u00a00.023), consistent with an early complementary kinetic profile. Over 12 months, endocapillary hypercellularity (E1) was the only independent histopathological factor associated with composite remission (OR 2.20; P\u00a0=\u00a00.022) and was associated with a shorter time to remission (log-rank P\u00a0=\u00a00.031). The resulting optimized 3-variable nomogram demonstrated good discrimination (time-dependent AUC 0.79 at 6 months and 0.83 at 12 months) with favorable internal calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In routine practice, the antiproteinuric effect of TR-budesonide appears largely preserved even in patients with advanced tubulointerstitial fibrosis. Early response is strongly associated with concomitant SGLT2i therapy, while the E1 lesions was associated with a faster trajectory toward composite clinical remission within this treated cohort, identifying a potentially reversible inflammatory phenotype that warrants further validation. These findings highlight the translational value of integrating histopathological phenotyping to characterize real-world remission trajectories.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1874529","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:42:59Z","timestamp":1788417779000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical remission trajectories and histopathological associations in patients with IgA nephropathy treated with targeted-release budesonide: a real-world cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Dafeng","family":"He","sequence":"first","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Xu","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Gao","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhu","family":"Jiang","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjin","family":"Liu","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanyan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinrui","family":"Li","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunlei","family":"Lu","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyue","family":"Zhu","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbin","family":"Mou","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangyu","family":"Bi","sequence":"additional","affiliation":[{"name":"Nephrology Department, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, Jiangsu, 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