Association of C4d Deposition with Clinical Outcomes in IgA Nephropathy

• DOI: 10.2215/cjn.09710913
• Publication Date: 2014-02-28T05:40:59Z
• Authors: Mario Espinosa; Rosa Ortega; Marina Sánchez; Alfons Segarra; Maria Teresa Salcedo; Fayna González; Rafael Camacho; Miguel Angel Vald...; Rocio Cabrera; Katia López; Fernando Pinedo; Eduardo Gutierrez; Alfonso Valera; Miryam Leon; Maria Angeles Cobo; Rosa Rodriguez; Jose Ballarín; Yolanda Arce; Beatriz García; María Dolores Muñoz; Manuel Praga
• Keywords: Adult; Male; Biopsy; Kaplan-Meier Estimate; Kidney; survival; End Stage Liver Disease; 03 medical and health sciences; 0302 clinical medicine; Complement C4b; Humans; complement; Retrospective Studies; Hypertelorism; Glomerulonephritis, IGA; IgA nephropathy; Middle Aged; Prognosis; Immunohistochemistry; Peptide Fragments; 3. Good health; Proteinuria; Mesangial Cells; Disease Progression; Female; Glomerular Filtration Rate

Several studies have suggested that activation of the complement system is a contributing pathogenic mechanism in IgA nephropathy (IgAN). C4d staining an inexpensive and easy-to-perform method for analysis renal biopsies. This study aimed to assess clinical prognostic implications IgAN.This retrospective cohort included 283 patients with IgAN 11 hospitals Spain who underwent biopsy between 1979 2010. The primary predictor was mesangial staining. Secondary predictors demographic, clinical, laboratory characteristics, Oxford pathologic classification criteria. end point cumulative percentage developed ESRD, defined as onset chronic dialysis or transplantation. analyzed by immunohistochemical using polyclonal antibody. Kaplan-Meier Cox proportional hazards analyses were performed evaluate effect on survival.There 109 (38.5%) 174 (61.5%) classified positive negative, respectively. Renal survival at 20 years 28% C4d-positive versus 85% C4d-negative (P<0.001). Independent risk factors associated ESRD follows: proteinuria (hazard ratio [HR] per every 1 g/d increase. 1.16; 95% confidence interval [95% CI], 1.03 1.31; P=0.01), eGFR (HR ml/min 1.73 m(2) increase, 0.96; CI, 0.94 0.97; P<0.001), T2 (tubular atrophy/interstitial fibrosis, >50%; HR, 4.42; 1.40 13.88; (HR, 2.45; 1.30 4.64; P=0.01).C4d-positive independent factor development IgAN. finding consistent possibility involved pathogenesis this disease.