Investigators of a multicenter retrospective study of 1,001 adults with biopsy-confirmed IgA nephropathy (IgAN) found that greater podocyte foot process effacement (FPE) on electron microscopy was associated with a more severe clinical and pathologic profile. Compared with mild FPE, severe FPE was accompanied by higher proteinuria, lower serum albumin and eGFR, more anemia, and greater tubulointerstitial and inflammatory injury. More than half of patients with severe FPE had nephrotic-range proteinuria, and 59.5% had an eGFR below 60 mL/min/1.73 m².
Among the 486 patients with at least 1 year of follow-up, severe FPE remained independently associated with a lower likelihood of complete remission after adjustment for age, sex, body mass index, kidney function, proteinuria, MEST-C score, and treatment regimen. The findings suggest that FPE severity may provide prognostic information beyond conventional clinical measures and light-microscopy findings when reviewing kidney-biopsy results. However, the authors caution that the retrospective Chinese cohort, short follow-up, substantial loss to follow-up, and small severe-FPE subgroup limit causal inference and generalizability. Longer prospective studies are needed to determine how FPE should influence treatment decisions.
Reference: Wang Y, Yang Y, Wen X, et al. Correlation of foot process effacement with clinicopathological features and short-term prognosis in IgA nephropathy. Ann Med. 2026 Dec;58(1):2674376. doi: 10.1080/07853890.2026.2674376.
