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Association between urinary C4d levels and disease progression in IgA nephropathy.
- Source :
-
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2024 Jul 31; Vol. 39 (8), pp. 1279-1287. - Publication Year :
- 2024
-
Abstract
- Background: C4d mesangial deposition, a hallmark of lectin pathway activation in immunoglobulin A nephropathy (IgAN), has been shown to be associated with risk of kidney failure. To date, the relationship between urinary C4d and renal outcome remain unelucidated.<br />Methods: A total of 508 patients with biopsy-proven IgAN were enrolled in this study, whose baseline urine samples at the time of biopsy were collected and the levels of urinary C4d were quantified by enzyme-linked immunosorbent assay. The time-averaged C4d (TA-C4d) and the change in proteinuria were measured in sequential urine samples obtained from IgAN patients. The kidney progression event was defined as a 50% estimated glomerular filtration rate (eGFR) decline or end-stage kidney disease or death.<br />Results: After a median follow-up of 36 months, 70 (13.8%) of the participants reached the kidney progression event. Higher levels of urinary C4d/Ucr were found to be associated with decreased eGFR, massive proteinuria, lower serum albumin levels, hypertension, and severe Oxford E and T scores. Upon adjusting for traditional risk factors (including demographics, eGFR, proteinuria, hypertension, Oxford pathologic score and immunosuppressive therapy), elevated levels of urinary C4d/Ucr were independently associated with an increased risk of chronic kidney disease progression [adjusted hazard ratio (HR) per standard deviation increment of log-transformed C4d/Ucr: 1.46; 95% CI 1.04-2.06; P = .030]. In reference to the low C4d group, the risk of poor renal outcome increased for the high C4d group (adjusted HR 1.93; 95% CI 1.05-3.54; P = .033). Additionally, a low baseline C4d level was independently associated with a favorable proteinuria response to immunosuppressive therapy at 3 months (adjusted relative risk 2.20; 95% CI 1.04-4.63, P = .038).<br />Conclusion: The urinary C4d, serving as a non-invasive biomarker, is associated with the progression of IgAN and holds the potential to predict proteinuria response in this disease.<br /> (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)
- Subjects :
- Humans
Male
Female
Adult
Follow-Up Studies
Prognosis
Risk Factors
Middle Aged
Proteinuria urine
Proteinuria etiology
Proteinuria diagnosis
Kidney Failure, Chronic urine
Kidney Failure, Chronic etiology
Kidney Failure, Chronic pathology
Glomerulonephritis, IGA urine
Glomerulonephritis, IGA pathology
Glomerulonephritis, IGA diagnosis
Disease Progression
Glomerular Filtration Rate
Complement C4b urine
Biomarkers urine
Peptide Fragments urine
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2385
- Volume :
- 39
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
- Publication Type :
- Academic Journal
- Accession number :
- 38178632
- Full Text :
- https://doi.org/10.1093/ndt/gfae001