1. Association of C4d Deposition with Clinical Outcomes in IgA Nephropathy
- Author
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Mario Espinosa, Rosa María Segismundo Rodríguez, Maria Angeles Cobo, Rosa Ortega, Miryam Leon, José Ballarín, Marina Sánchez, Yolanda Arce, Maria Teresa Salcedo, Rafael Camacho, Alfons Segarra, Eduardo Gutiérrez, Fernando Pinedo, María Dolores Carbonero Muñoz, Katia López, Beatriz Lozano García, Alfonso Valera, Miguel Angel Valdivia, Manuel Praga, Rocio Cabrera, and F. González
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,Epidemiology ,Biopsy ,Renal function ,Kaplan-Meier Estimate ,Kidney ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,Gastroenterology ,survival ,Nephropathy ,End Stage Liver Disease ,Young Adult ,Risk Factors ,Internal medicine ,Complement C4b ,medicine ,Humans ,complement ,Retrospective Studies ,Transplantation ,Hypertelorism ,medicine.diagnostic_test ,Proportional hazards model ,business.industry ,Glomerulonephritis, IGA ,Retrospective cohort study ,Original Articles ,IgA nephropathy ,Middle Aged ,Prognosis ,medicine.disease ,Immunohistochemistry ,Peptide Fragments ,Proteinuria ,medicine.anatomical_structure ,Nephrology ,Mesangial Cells ,Disease Progression ,Female ,Renal biopsy ,business ,Glomerular Filtration Rate - Abstract
Background and objectivesSeveral studies have suggested that activation of the complement system is a contributing pathogenic mechanism in IgA nephropathy (IgAN). C4d staining is an inexpensive and easy-to-perform method for the analysis of renal biopsies. This study aimed to assess the clinical and prognostic implications of C4d staining in IgAN.Design, setting, participants, & measurementsThis retrospective cohort study included 283 patients with IgAN in 11 hospitals in Spain who underwent a renal biopsy between 1979 and 2010. The primary predictor was mesangial C4d staining. Secondary predictors included demographic, clinical, and laboratory characteristics, and Oxford pathologic classification criteria. The primary end point was the cumulative percentage of patients who developed ESRD, defined as onset of chronic dialysis or renal transplantation. C4d was analyzed by immunohistochemical staining using a polyclonal antibody. Kaplan-Meier and Cox proportional hazards analyses were performed to evaluate the effect of C4d staining on renal survival.ResultsThere were 109 patients (38.5%) and 174 patients (61.5%) who were classified as C4d positive and C4d negative, respectively. Renal survival at 20 years was 28% in C4d-positive patients versus 85% in C4d-negative patients (P50%; HR, 4.42; 95% CI, 1.40 to 13.88; P=0.01), and C4d-positive staining (HR, 2.45; 95% CI, 1.30 to 4.64; P=0.01).ConclusionsC4d-positive staining is an independent risk factor for the development of ESRD in IgAN. This finding is consistent with the possibility that complement activation is involved in the pathogenesis of this disease.
- Published
- 2014