Glomerular Galactose-Deficient IgA1(KM55) Positive May Predict Poorer Prognosis in Coexisting Primary Membranous Nephropathy and IgA Nephropathy Patients

Round 1

Reviewer 1 Report

This is an interesting manuscript to assess the role of Gd-IgA1 in PMN/IgAN patients and concluded that PMN/IgAN patients with KM55+ have worse prognosis. The study is well designed and presented, however, there are some issues that need to be addressed:

1. Based on this study, PMN/IgA deposition patients group has relatively mild clinical and pathological manifestations. Could you explain why the PMN/IgA deposition group had a higher proportion of nephrotic syndrome?

2.  It seems PMN/IgA deposition group has a higher level of PMN pathogenic biomarkers than PMN/IgA patients (table 3). This may affect the prognosis. Is the prognosis of PMN/IgA deposition group different from PMN/IgA group?

3. Table 7, association between KM55+ and prognosis was only analyzed in 50 patients. However, there were 85 PMN/IgA patients in total. Could you explain it?

4. In the first paragraph of Discussion, please do not repeat the information that have already shown in Introduction. It might be better to report the main results here. Please rephrase the last sentence” This study mainly focused on these retrospective cohort.” 

5. Based on your results, PMN/IgAN patients with KM55+ had worse prognosis. Do the authors have any treatment suggestions to those specific group of patients?

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors of the manuscript entitled: Glomerular Galactose-deficient IgA1(KM55) positive May Predict Poorer Prognosis in coexisting Primary Membranous Nephropathy and IgA Nephropathy Patients by Cheng et al. studied simultaneously Gd-IgA1 and PLA2R molecules in both the circulating and renal tissues of these PMN/IgAN patients.

The manuscript provides interesting information, but requires corrections and clarifications before it is published. Below are my suggestions for authors:

1. Please correct the spacing between the text and the citation, e.g. 37, 41. Please review the entire text

2. Selection of statistical significance * and the added symbol * in the description of all tables will improve readability

3. In the case of histological image methodology, I would suggest rewriting the descriptions of fluorescence intensity and % tissue involvement in the form of tables. In addition, please consider whether it is worth specifying the parameters regarding fluorescence intensity better. In your work, we have included the fluorescence intensity as 1+, 2+, 3+ (positive), while samples with no fluorescence were negative. Could you make the positive criteria more precise?

4. In Figure 1F we have given the size of 5µm, why is this parameter not present in the other images? Please add to the other images, information about the enlargement. This will improve readability, reception

5. Please separate the conclusions from the discussion section, line 360 should not be in the discussion, but should be the conclusions section.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The revised manuscript is highly improved and all the concerns have been solved.

Reviewer 2 Report

Dear authors, thank you for considering the suggestions. As for the last suggestion, separating the conclusions section is sufficient. The article in its current form can be published.