Alleviation of refractory IgA nephropathy by intensive fecal microbiota transplantation: the first case reports

Figures & data

Figure 1. Treatment timeline, Alpha diversity, Beta diversity, and 24-h urinary protein of patient A before, during, and post FMT. (A) Treatment timeline of patient A. The timeline shows the major clinical events during the treatment process of patient A. M: month; FK506: tacrolimus; MMF: mycophenolate mofetil; FMT: fecal microbiota transplantation. (B) Alpha diversity (Chao index), which refers to the diversity within a particular region or ecosystem and is a comprehensive indicator of richness and evenness of gut microbiota in patient A. Black dots represent different samples collected from patient A before (A_Pre), during (A_FMT), and post FMT (A_Post). (C) Beta diversity (PC_OA index), which reflects the significant microbial community difference between gut microbiota of samples from patient A. Red dots represent samples from donors; Samples collected from patient A before (A_Pre, blue square), during (A_FMT, green triangle), and post FMT (A_Post, yellow diamond). (D) 24-h urinary protein of patient A before, during, and post FMT. Red solid line indicates the trend.

Table 1. Clinical parameters of patient A and B before, during, and post FMT.

Patient A	Before FMT	Number of FMT (times)							Follow up (month)
		20	40	55	65	75	87	97	1	3	6
24-h total urine protein (mg)	2605	2278	2237	1850	1517	1580	2249	1642	2116	1390	1000
eGFR (mL/min/1.73 m^2)	51.0	49.9	42.9	51.6	54.5	59.3	64.9	57.9	52.7	49.4	48.4
Serum creatinine (umol/L)	106	108	123	105	100	93	86	95	103	109	111
Serum albumin (g/L)	32.8	34.6	39.5	31.7	37	37.2	36.6	40	42.7	41.7	43.5
Cystatin C (mg/L)	0.99	1.38	1.26	1.2	1.57	1.27	1.32	1.40	1.38	1.52	1.35
Patient B	Before FMT	Number of FMT (times)						Follow up (month)
		10	20	30	40	50	60	1	3	6
24-h total urine protein (mg)	2744	1365	1368	1350	1178	1080	1020	1070	1629	1670
eGFR (mL/min/1.73 m^2)	72.4	69.6	74.5	86.6	68.7	66.9	74.5	75.5	74.5	71.5
Serum creatinine (umol/L)	84	87	82	72	88	90	82	81	82	85
Serum albumin (g/L)	32.6	33.5	36.1	33.6	34.9	36.7	39	43.1	39.8	42.1
Cystatin C (mg/L)	1.18	1.20	1.13	1.06	1.02	1.21	1.24	1.23	1.18	1.09

FMT: fecal microbiota transplantation; eGFR: estimated glomerular filtration rate.

Figure 2. Treatment timeline, Alpha diversity, Beta diversity, and 24-h urinary protein of patient B before, during, and post FMT. (A) Treatment timeline of patient B. The timeline shows the major clinical events during the treatment process of patient B. M: month; CTX: cyclophosphamide; FK506: tacrolimus; MMF: mycophenolatemofetil; FMT: fecal microbiota transplantation. (B) Alpha diversity (Chao index) of gut microbiota in patient B. Black dots represent different samples collected from patient B before (B_Pre), during (B_FMT), and post FMT (B_Post). (C) Beta diversity (PC_OA index) of gut microbiota in patient B. Red dots represent samples from donors; Samples collected from patient B before (B_Pre, blue square), during (B_FMT, green triangle), and post FMT (B_Post, yellow diamond). (D) 24-h urinary protein of patient B before, during, and post FMT. A Red solid line indicates the trend.

Data availability statement

The sequencing data of our manuscript has been deposited in data repository, National Center of Biotechnology Information (NCBI) (NO.PRJNA630819).