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Abedi M, Nili F, Dehkhoda F, Abdollahi A, Salarvand S. Evaluation of C4d expression and staining patterns by immunohistochemistry in renal biopsy samples with focal segmental glomerulosclerosis and minimal change disease. Ann Diagn Pathol 2024; 70:152281. [PMID: 38417352 DOI: 10.1016/j.anndiagpath.2024.152281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION C4d is an activation product of lectin pathway of complement. Glomerular deposition of C4d is associated with poor prognosis in different types of immune-related glomerulonephritis. The present study was conducted to investigate expression level of C4d and its staining pattern in renal biopsy of patients with focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) by immunohistochemistry method. MATERIALS AND METHODS In this retrospective cross-sectional study, renal biopsy specimens from 46 samples of MCD, 47 samples of FSGS, and 15 samples without glomerular disease as the controls, were subjected to immunohistochemistry staining with C4d. Demographic characteristics and information obtained from light and electron microscopy (EM) of patients were also extracted from their files. RESULTS C4d positive staining was observed in 97.9 % of FSGS and 43.5 % of MCD samples, which showed a statistically significant difference (P < 0.001). The sensitivity and specificity of C4d expression for diagnosing FSGS were 97.9 % and 56.5 %, respectively. There was no significant correlation between C4d expression and any of the light and electron microscopy findings, including presence of foam cells, mesangial matrix expansion, interstitial fibrosis and tubular atrophy, and basement membrane changes in MCD patients. Also, no significant correlation was observed between C4d expression and clinical symptoms of proteinuria or prolonged high level of creatinine in patients with MCD. DISCUSSION AND CONCLUSION The expression of C4d marker had a good sensitivity and negative predictive value in the diagnosis of FSGS.
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Affiliation(s)
- Maryam Abedi
- Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nili
- Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Dehkhoda
- Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Salarvand
- Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Kurultak I, Gungor O, Ozturk S, Dirim AB, Eren N, Yenigün E, Dal EA, Dincer MT, Bora F, Akgur S, Sumnu A, Dursun B, Sipahi S, Cetinkaya H, Sahin I, Sahin G, Yilmaz M, Vatansever B, Aydın E, Ulu MS, Gundogdu A, Ustundag S, Sayarlioglu H, Kumru G, Elcioglu OC, Aydın Z, Selcuk NY, Onal Guclu C, Oruc M, Kucuk M, Aktas N, Derici U, Suleymanlar G. Clinical and histopathological characteristics of primary focal segmental glomerulosclerosis in Turkish adults. Sci Rep 2024; 14:6748. [PMID: 38514826 PMCID: PMC10957996 DOI: 10.1038/s41598-024-57305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/16/2024] [Indexed: 03/23/2024] Open
Abstract
The data regarding primary FSGS (pFSGS) from different parts of the world differ. While the prevalence of pFSGS has been increasing in Western countries like the USA, it follows an inconsistent trend in Europe and Asia and a decreasing trend in Far Eastern countries such as China in the last two decades. There are undetermined factors to explain those national and geographic discrepancies. Herein, we aimed to reveal the current prevalence with clinical and histopathological characteristics of pFSGS in Turkish adults. This study includes the biopsy-proven pFSGS patients data recorded between 2009 and 2019, obtained from the national multicenter primary glomerulonephritis registry system of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database. 850 of the 3875 primer glomerulonephritis patients(21.9%) have pFSGS. The mean age is 40.5 ± 14.2 and 435 (51.2%) of patients are male. Nephrotic syndrome is the most common biopsy indication (59.2%). 32.6% of patients have hematuria, 15.2% have leukocyturia and 7.8% have both. Serum creatinine, albumin, and proteinuria are 1.0 mg/dL (IQR = 0.7-1.4) mg/dl, 3.4 ± 0.9 g/dl, 3400 mg/day(IQR, 1774-5740), respectively. Females have lower mean arterial pressure (- 2.2 mmHg), higher eGFR (+ 10.0 mL/min/1.73 m2), and BMI (+ 1.6 kg/m2) than males. Thickened basal membrane(76.6%) and mesangial proliferation (53.5%) on light microscopy are the major findings after segmental sclerosis. IgM (32.7%) and C3 (32.9%) depositions are the most common findings on immunofluorescence microscopy. IgM positivity is related to lower eGFR, serum albumin, and higher proteinuria. The prevalence of pFSGS is stable although slightly increasing in Turkish adults. The characteristics of the patients are similar to those seen in Western countries.
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Affiliation(s)
- Ilhan Kurultak
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Trakya University, 22030, Edirne, Turkey.
| | - Ozkan Gungor
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Sutcu Imam University, Kahramanmaras, Turkey
| | - Savas Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul, Turkey
| | - Necmi Eren
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Kocaeli University, Kocaeli, Turkey
| | - Ezgi Yenigün
- Department of Internal Medicine, Division of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Elbis Ahbab Dal
- Department of Internal Medicine, Division of Nephrology, Health Science University, Istanbul Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Feyza Bora
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Akdeniz University, Antalya, Turkey
| | - Suat Akgur
- Department of Internal Medicine, Division of Nephrology, Kutahya Health Science University, Evliya Celebi Yuksek Ihtisas Training and Research Hospital, Kutahya, Turkey
| | - Abdullah Sumnu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Medipol University, Istanbul, Turkey
| | - Belda Dursun
- Faculty of Medicine, Department of InternalMedicine, Division of Nephrology, Pamukkale University, Denizli, Turkey
| | - Savas Sipahi
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Sakarya University, Sakarya, Turkey
| | - Hakki Cetinkaya
- Department of Internal Medicine, Division of Nephrology, Sultan Abdulhamid Training and Research Hospital, Istanbul, Turkey
| | - Idris Sahin
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Inonu University, Malatya, Turkey
| | - Garip Sahin
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Murvet Yilmaz
- Department of Internal Medicine, Division of Nephrology, Health Science University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Bulent Vatansever
- Department of Internal Medicine, Division of Nephrology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Emre Aydın
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Dicle University, Diyarbakir, Turkey
| | - Memnune Sena Ulu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Afyon Kocatepe University, Afyon, Turkey
| | - Ali Gundogdu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Erciyes University, Kayseri, Turkey
| | - Sedat Ustundag
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Trakya University, 22030, Edirne, Turkey
| | - Hayriye Sayarlioglu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Samsun 19 Mayis University, Samsun, Turkey
| | - Gizem Kumru
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Ankara University, Ankara, Turkey
| | - Omer C Elcioglu
- Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Zeki Aydın
- Department of Internal Medicine, Division of Nephrology, Darıca Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Nedim Yılmaz Selcuk
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Selcuk University, Konya, Turkey
| | - Ceren Onal Guclu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Hacettepe University, Ankara, Turkey
| | - Meric Oruc
- Department of Internal Medicine, Division of Nephrology, Kartal Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Mehmet Kucuk
- Department of Internal Medicine, Division of Nephrology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Nimet Aktas
- Department of Internal Medicine, Division of Nephrology, Health Science University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ulver Derici
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Gazi University, Ankara, Turkey
| | - Gultekin Suleymanlar
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Akdeniz University, Antalya, Turkey
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Shankar M, Gurusiddiah SC, Vinay KS, Aralapuram K, Siddalingappa R, Satheesh G. C3 Dominant Collapsing Focal Segmental Glomerulosclerosis - A Report of Two Rare Cases. Indian J Nephrol 2024; 34:70-73. [PMID: 38645916 PMCID: PMC11003605 DOI: 10.4103/ijn.ijn_250_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/18/2022] [Indexed: 04/23/2024] Open
Abstract
Collapsing focal segmental glomerulosclerosis (FSGS) a heterogeneous group of disorders, rather than a single disease entity. Kidney biopsy shows segmental or globally collapsed, sclerotic glomerular capillaries. There is also hypertrophy and hyperplasia of overlying glomerular epithelial cells. Immuno-fluorescence is negative or has non-specific deposits of immunoglobulins and C3. We present two cases of C3 dominant collapsing FSGS. Both the cases were non-responsive to therapy and had a poor outcome. This calls for research to study the role of the complement pathway in the pathogenesis of FSGS.
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Affiliation(s)
- Mythri Shankar
- Department of Nephrology, Institute of Nephrourology, Bengaluru, Karnataka, India
| | | | - K. S. Vinay
- Department of Nephrology, Institute of Nephrourology, Bengaluru, Karnataka, India
| | - Kishan Aralapuram
- Department of Nephrology, Institute of Nephrourology, Bengaluru, Karnataka, India
| | | | - Gouri Satheesh
- Department of Nephrology, Institute of Nephrourology, Bengaluru, Karnataka, India
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4
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Peng Y, Ju T, Gao C, Xia Z, Wang M, Sun X, Wang R, Li X, Wei Y, Jia L, Chen H. A clinicopathological and prognostic study of 18 children with C1q nephropathy and focal segmental glomerulosclerosis: an 18-year experience from a single center. J Nephrol 2023:10.1007/s40620-023-01679-9. [PMID: 37428438 DOI: 10.1007/s40620-023-01679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/08/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND C1q nephropathy is a relatively rare glomerulonephritis characterized by dominant mesangial deposition of C1q. Even though C1q nephropathy has been described for more than three decades, the clinicopathological features and renal outcomes remain unclear. C1q nephropathy may present diverse morphological patterns, including focal segmental glomerulosclerosis and, the notion of C1q nephropathy as a separate disease entity is still debated. This study aimed to describe the clinical and prognostic relevance of C1q nephropathy in children with primary focal segmental glomerulosclerosis. METHODS Three hundred eighty-nine children were diagnosed with primary focal segmental glomerulosclerosis in Jinling Hospital from 2003 to 2020. Among them, 18 cases fulfilled the criteria for C1q nephropathy. We then selected as a control group 18 children with primary focal segmental glomerulosclerosis without C1q nephropathy matched to those with C1q nephropathy for age, sex, and period of renal biopsy. Clinical and prognostic parameters were compared in children with and without C1q nephropathy. Renal end-point was defined as a ≥ 40% reduction in estimated glomerular filtration rate or end-stage renal disease. RESULTS Four point sixty-three percent (18/389) of primary focal segmental glomerulosclerosis cases were diagnosed with C1q nephropathy. The male-to-female ratio of patients diagnosed with C1q nephropathy was 1:1. The median age at biopsy and age at onset was 15.63 (13.00-16.50) years and 14.50 (9.00-16.00) years, respectively. The prevalence of nephrotic syndrome, hematuria, and hypertension was 38.90% (7/18), 72.20% (13/18), and 33.30% (5/18), respectively. Four (22.2%) patients were steroid-dependent, 13 (72.2%) patients were steroid-resistant, and 1 (5.6%) patient developed secondary steroid-resistance. During a follow-up of 52.24 (25.00-72.47) months, 10 (55.6%) patients achieved remission, and 5 (27.8%) progressed to the end-point [including 2 (11.11%) patients who developed end-stage kidney disease]. There was no significant difference in the estimated end-stage renal disease-free survival rates, the estimated end-point-free survival rates, and the long-term remission rate between patients with and without C1q nephropathy (Kaplan-Meier, Log-rank, all P > 0.05). CONCLUSIONS C1q nephropathy was rare in pediatric patients with focal segmental glomerulosclerosis. These patients usually had poor response to steroids. The long-term renal outcomes and remission of children with primary focal segmental glomerulosclerosis with C1q nephropathy were comparable to those without C1q nephropathy.
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Affiliation(s)
- Yingchao Peng
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Tao Ju
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Chunlin Gao
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China.
| | - Zhengkun Xia
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China.
| | - Meiqiu Wang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaoyi Sun
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ren Wang
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaojie Li
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yaqin Wei
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Lili Jia
- Department of Information, Jinling Hospital, Nanjing, China
| | - Huangyu Chen
- Department of Information, Jinling Hospital, Nanjing, China
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5
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Amer F, Syed M, Afzal A, Hussain M, Hassan U, Bashir S, Hameed M, Ishtiaq S. IgM and C3 Deposition in Primary Focal Segmental Glomerulosclerosis (FSGS): A Clinical and Histopathological Spectrum. Cureus 2023; 15:e37346. [PMID: 37182061 PMCID: PMC10169510 DOI: 10.7759/cureus.37346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is a common renal disorder, characterized by progressive segmental sclerosis of renal glomeruli and clinical symptoms corresponding to proteinuria. Classically, it is not considered to be an antibody-mediated disease, however, IgM and C3 deposition may be seen in a subset of cases of FSGS. The impact of this immune deposition on histopathological features in renal core biopsies, on the urinary biochemical parameters, and the clinical outcomes, has not been previously investigated in our population. The aim of this study is to analyze the aforementioned parameters in patients with primary FSGS having antibody deposition as compared to those who do not have any antibody deposition. Some 155 patients diagnosed with FSGS were retrospectively enrolled in our study. The renal biopsies were reviewed for histopathological features and immunofluorescence (IF) findings of IgM and C3 glomerular deposition. These histological features were then compared with the biochemical parameters as well as the clinical outcomes of patients. The patients were assigned to Groups 1 and 2 based on the IF findings. The IgM and/or C3 glomerular deposition had a low incidence in patients with primary FSGS in our study (28.3%). Patients having IgM and C3 co-deposition had a significantly longer time duration since the onset of their clinical symptoms; active disease duration (42 months vs 22 months, p=0.049). The mean pre-treatment serum creatinine of patients with IgM and C3 co-deposition was 6.00 mg/dL as compared to 3.29 mg/dL in patients with no immune deposition (p=0.037). The immune deposition was associated with higher rates of segmental and global glomerulosclerosis, but this finding along with other evaluated histological parameters did not show statistical significance. The number of patients having IgM and/or C3 deposition and with active steroid use/renal dialysis was similar to patients having no IgM and/or C3 deposition. The IgM and/or C3 deposition in FSGS has a low incidence within and is not associated with any significant differences in histological parameters on renal core biopsies of patients from the Pakistani population. IgM and/or C3 deposition is also associated with a significantly longer duration of active disease and these patients may present with higher pre-treatment serum creatinine. Other biochemical parameters and clinical outcomes appear comparable between the groups based on the available clinical data.
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Affiliation(s)
- Faizan Amer
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Madiha Syed
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | | - Mudassar Hussain
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Usman Hassan
- Pathology, Shaukat Khanum Memoiral Cancer Hospital and Research Centre, Lahore, PAK
| | - Shaarif Bashir
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Maryam Hameed
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Ju T, Peng Y, Wei Y, Li X, Wang M, Wang R, Yang X, Zhang Z, Gao C, Xia Z. IgM deposition is a risk factor for delayed remission and early relapse of the pediatric minimal change disease. Front Pediatr 2023; 11:1072969. [PMID: 36816381 PMCID: PMC9936809 DOI: 10.3389/fped.2023.1072969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Minimal change disease (MCD) is the most common pathological subtype of pediatric idiopathic nephrotic syndrome (INS). It has been suggested that IgM deposition might predict kidney function deterioration in the course of MCD. However, the specific role of IgM deposition in the prognosis of MCD is still controversial. This study aims to investigate the clinical significance of IgM deposition on delayed remission and early relapse in a pediatric population. METHODS This study enrolled 283 children diagnosed with MCD by renal biopsy in a single center from 2010 to 2022. These cases were divided into two groups according to the histopathological deposition of IgM. Patients' demographics, clinical parameters, and follow-up data were collected and analyzed. The primary and secondary outcomes were defined as the time to the first remission and the first relapse. RESULTS The IgM-positive group had a weaker response to steroids (steroid-sensitive: 23.5% vs. 40.8%; steroid-dependent: 74.0% vs. 51.0%; steroid-resistant: 18.4% vs. 8.2%, P = 0.001), and showed more recurrent cases (47.2% vs. 34.4%, P = 0.047) compared with the IgM-negative group. The Kaplan-Meier analysis showed that the IgM-positive group had a lower cumulative rate of the first remission (Log-rank, P < 0.001) and a higher rate of the first relapse (Log-rank, P = 0.034) than the IgM-negative group. Multivariate Cox analysis showed that IgM deposition was independently associated with the delayed first remission (hazard ratio [HR] = 0.604, 95% confidence interval [CI] = 0.465-0.785, P < 0.001) and the early first relapse (HR = 1.593, 95% CI = 1.033-2.456, P = 0.035). CONCLUSION IgM deposition was associated with a weaker steroid response. MCD children with IgM deposition were prone to delayed first remission and early first relapse.
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Affiliation(s)
- Tao Ju
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yingchao Peng
- Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yaqin Wei
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xiaojie Li
- Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Meiqiu Wang
- Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ren Wang
- Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - Xiao Yang
- Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - Zhiqiang Zhang
- Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - Chunlin Gao
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - Zhengkun Xia
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Pediatrics, Jinling Hospital, Nanjing, China
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7
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Peng Y, Li B, Li X, Ju T, Zhang Z, Wang P, Sun T, Shu J, Wang M, Sun X, Chen H, Gao C, Xia Z. Glomerular capillary C3 deposition as a risk factor for unfavorable renal outcome in pediatric primary focal segmental glomerular sclerosis. Front Pediatr 2023; 11:1137375. [PMID: 37025292 PMCID: PMC10070806 DOI: 10.3389/fped.2023.1137375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Some patients with primary focal segmental sclerosis (FSGS) demonstrate complement 3 (C3) deposition in glomerular capillary loops (Cap-C3) and/or mesangial area (Mes-C3). The clinicopathological and prognostic significance of C3 deposition remains incompletely investigated, especially in the pediatric cohort. Methods We retrospectively analyzed 264 children of biopsy-proven primary FSGS between January 2003 and December 2020. The correlation between Cap-C3 and renal outcome was evaluated by the Kaplan-Meier method and Cox multivariate regression analysis. Renal end-point event was defined as the development of end-stage renal disease, death for renal disease, or an estimated glomerular filtration rate reduction by at least 50% from baseline. Results Among the 264 patients, 30 (11.4%) had Cap-C3. Kaplan-Meier analysis showed that patients with Cap-C3 had significantly lower renal survival rates than patients without Cap-C3 (60.17% vs. 84.71% at 5 years, 39.49% vs. 65.55% at 10 years, P < 0.01). Cox multivariate regression analysis showed that Cap-C3 was an independent risk factor for poor renal outcome (HR 3.53, 95% CI 1.22-10.19, P = 0.02). Conclusion Glomerular capillary C3 deposition was an independent risk factor for unfavorable renal outcome in children with primary FSGS.
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Affiliation(s)
- Yingchao Peng
- Department of Pediatrics, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Banghai Li
- Department of Medical Insurance Section, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiaojie Li
- Department of Pediatrics, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Tao Ju
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiqiang Zhang
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Peipei Wang
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Tao Sun
- Department of Medical Information, Jinling Hospital, Nanjing, China
| | - Jiaping Shu
- Department of Medical Information, Jinling Hospital, Nanjing, China
| | - Meiqiu Wang
- Department of Pediatrics, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Xiaoyi Sun
- Department of Pediatrics, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Huangyu Chen
- Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - Chunlin Gao
- Department of Pediatrics, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Correspondence: Zhengkun Xia Chunlin Gao
| | - Zhengkun Xia
- Department of Pediatrics, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Correspondence: Zhengkun Xia Chunlin Gao
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8
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Abstract
Idiopathic nephrotic syndrome often responds to immunosuppressive treatment. Nevertheless, this syndrome-and the drugs used to treat it-remain important causes of patient morbidity. Idiopathic nephrotic syndrome is usually caused by minimal change disease or FSGS, diseases that primarily affect the podocytes. In spite of decades of research, the underlying causes of both diseases remain incompletely understood. There is, however, a large body of observational and experimental data linking the immune system with both minimal change disease and FSGS, including associations with systemic infections and hematologic malignancies. Perhaps most compellingly, many different immunomodulatory drugs are effective for treating idiopathic nephrotic syndrome, including biologic agents that have well-defined immune targets. In fact, the unexpected efficacy of targeted therapeutic agents has provided important new insights into the pathogenesis of these diseases. Given the large number of drugs that are available to deplete or block specific cells and molecules within the immune system, a better understanding of the immunologic causes of idiopathic nephrotic syndrome may lead to better diagnostic and therapeutic approaches.
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Affiliation(s)
- Ruth E. Campbell
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado
| | - Joshua M. Thurman
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado
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9
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Liu J, Guan F. B cell phenotype, activity, and function in idiopathic nephrotic syndrome. Pediatr Res 2022:10.1038/s41390-022-02336-w. [PMID: 36316536 DOI: 10.1038/s41390-022-02336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022]
Abstract
Idiopathic nephrotic syndrome (INS) is the most frequent glomerular disease in childhood. However, its underlying etiology mechanism lacks thorough understanding. Previous studies have described INS as a T cell functional disorder resulting in increased plasma lymphocyte-derived permeability factors. In children with frequent relapses of nephrotic syndrome, the mechanism underlying the therapeutic efficacy of CD20 monoclonal antibodies in depleting B cells may provide additional evidence in exploring the critical role of B lymphocytes in INS pathogenesis. Previous studies have proposed that RTX bound to CD20 through antibody-dependent and complement-dependent cytotoxicity and led to lytic clearance of B cells. Additionally, RTX exerted an effect by blocking the interaction between B and T cells or regulating homeostasis and functions of T cell subsets. Recent studies on the development, differentiation, and activation of B-lymphocytes in glomerular diseases have suggested that the B-lymphocytes participate in the INS pathogenesis through interaction with T cells, secretion of antibodies, or production of cytokines. In this study, we aimed to provide a detailed description of the current knowledge on the development, differentiation, activity, functions, and related regulating factors of B cells involved in INS. Thus, further understanding of the immunopathogenesis of INS may offer some opportunities in precisely targeting B cells during therapeutic interventions. IMPACT: The topic "B cells play a role in glomerular disease" is a novel point, which is not completely described previously. We described interactions between T and B cells and immunoglobulin, IgG, IgM, IgE, etc. as well in glomerular disease. The research of regulatory factors associated with B cell's function, like BAFF, is a hot topic in other diseases; however, it is rare in glomerular disease.
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Affiliation(s)
- Junhan Liu
- Department of Pediatrics, Affiliated Hospital of Xuzhou Medical University, 221002, Xuzhou, Jiangsu, China
| | - Fengjun Guan
- Department of Pediatrics, Affiliated Hospital of Xuzhou Medical University, 221002, Xuzhou, Jiangsu, China.
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Retinal drusen in glomerulonephritis with or without immune deposits suggest systemic complement activation in disease pathogenesis. Sci Rep 2022; 12:8234. [PMID: 35581312 PMCID: PMC9114393 DOI: 10.1038/s41598-022-12111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Retinal drusen are characteristic of macular degeneration and complement activation, but also occur in C3, lupus and IgA nephropathy. This cross-sectional observational study compared drusen counts in different forms of glomerulonephritis. Consecutive individuals with glomerulonephritis attending a general renal or transplant clinic underwent retinal imaging with a non-mydriatic camera. Drusen were counted in deidentified images by trained graders, compared with matched hospital patients, and correlated with clinical features. Eighty-four individuals with glomerulonephritis had a mean drusen count of 10 ± 27 compared with 3 ± 8 in hospital controls (p = 0.007). Fourteen individuals with glomerulonephritis (17%) and 4 hospital controls (4/49, 8%) had increased drusen counts (≥ 10) (p = 0.20). Increased drusen counts ≥ 10 were present in 13 (13/63, 21%) of those with glomerulonephritis and immune deposits [membranous (n = 8), antiglomerular basement membrane nephritis (n = 6), FSGS (n = 49)], and one of the 21 (5%) with glomerulonephritis without immune deposits [ANCA-associated (n = 15), minimal change disease (n = 6)]. In antibody-mediated glomerulonephritis (n = 14), mean drusen counts were 2 ± 3 in individuals with normal kidney function, 16 ± 41 with impaired function and 5 ± 7 with kidney failure . Mean counts were 24 ± 56 in individuals with glomerular IgG deposits and 1 ± 1 in those without (p = 0.76), and 23 ± 60 with complement deposits and 4 ± 8 in those without. Drusen counts were also less in immunosuppressed individuals (p = 0.049). The demonstration of retinal drusen in some forms of glomerulonephritis is consistent with systemic complement activation, and suggests that treatment targeting the complement pathways is worthwhile.
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Wang F, Yu J, Zhang L, Zhang Y, Zhang J, Liu B, Yang X. Clinical relevance of glomerular IgM deposition in patients with lupus nephritis. BMC Immunol 2021; 22:75. [PMID: 34876020 PMCID: PMC8650561 DOI: 10.1186/s12865-021-00467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of the study was to investigate the clinical relevance of IgM deposition in patients with lupus nephritis (LN) in a large cohort. RESULTS 217 patients with renal biopsy-proven active LN were enrolled. The associations between glomerular IgM deposition and clinicopathological parameters were further analyzed. IgM deposition was positively correlated with glomerular C1q and C3 deposition moderately (r = 0.436, P < 0.001; r = 0.408, P < 0.001, respectively), and inversely correlated with plasma levels of C3 and CFH mildly (r = - 0.138, P = 0.043; r = - 0.147, P = 0.037, respectively). By multivariate analysis, we found that glomerular IgM deposition independently contributed to glomerular C3 deposition in patients with LN (OR = 2.002, 95% CI 1.295-3.094, P = 0.002). In addition, we also found that patients with IgM 0-2+ had similar plasma CFH levels, but in patients with IgM3+-4+, plasma CFH levels were significantly lower (300.4 ± 155.8 μg/mL vs. 429.9 ± 187.5 μg/mL, P < 0.001). Furthermore, patients with high density of glomerular IgM and low levels of CFH had heavier proteinuria, higher serum creatinine and lower plasma C3 levels (5.7 ± 3.1 g/d vs. 4.7 ± 3.5 g/d, P = 0.037; 150.1 ± 121.0 μmol/L vs. 105.6 ± 97.1 μmol/L, P = 0.005; 0.3 ± 0.2 μg/L vs. 0.4 ± 0.2 μg/L, P = 0.04, respectively), comparing with those with low density of glomerular IgM and low levels of CFH. CONCLUSIONS Our results suggested the involvement of glomerular deposited IgM in complement activation and renal injury in LN.
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Affiliation(s)
- Fengmei Wang
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Jirong Yu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Lei Zhang
- Department of Nephrology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
| | - Yan Zhang
- Department of Nephrology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
| | - Jie Zhang
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bicheng Liu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China.
| | - Xiaowei Yang
- Department of Nephrology, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China.
- Department of Nephrology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
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Podestà MA, Ponticelli C. Autoimmunity in Focal Segmental Glomerulosclerosis: A Long-Standing Yet Elusive Association. Front Med (Lausanne) 2020; 7:604961. [PMID: 33330569 PMCID: PMC7715033 DOI: 10.3389/fmed.2020.604961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/26/2020] [Indexed: 01/17/2023] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is a histological term that describes a pathologic renal entity affecting both adults and children, with a wide array of possible underlying etiologies. Podocyte damage with scarring, the hallmark of this condition, leads to altered permeability of the glomerular barrier, which may result in massive proteinuria and relentless renal function deterioration. A definite cause of focal segmental glomerulosclerosis can be confirmed in a minority of cases, while most forms have been traditionally labeled as primary or idiopathic. Despite this definition, increasing evidence indicates that primary forms are a heterogenous group rather than a single disease entity: several circulating factors that may affect glomerular permeability have been proposed as potential culprits, and both humoral and cellular immunity have been implicated in the pathogenesis of the disease. Consistently, immunosuppressive drugs are considered as the cornerstone of treatment for primary focal segmental glomerulosclerosis, but response to these agents and long-term outcomes are highly variable. In this review we provide a summary of historical and recent advances on the pathogenesis of primary focal segmental glomerulosclerosis, focusing on implications for its differential diagnosis and treatment.
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Forster BM, Nee R, Little DJ, Greasley PJ, Hughes JB, Gordon SM, Olson SW. Focal Segmental Glomerulosclerosis, Risk Factors for End Stage Kidney Disease, and Response to Immunosuppression. KIDNEY360 2020; 2:105-113. [PMID: 35368810 PMCID: PMC8785735 DOI: 10.34067/kid.0006172020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/30/2020] [Indexed: 02/04/2023]
Abstract
Background FSGS is a heterogeneic glomerular disease. Risk factors for kidney disease ESKD and the effect of immunosuppression treatment (IST) has varied in previously published cohorts. These cohorts were limited by relatively small case numbers, short follow-up, lack of racial/ethnic diversity, a mix of adult and pediatric patients, lack of renin-angiotensin-aldosterone system (RAAS) inhibition, or lack of subgroup analysis of IST. Methods We compared demographics, clinical characteristics, histopathology, and IST to long-term renal survival in a large, ethnically diverse, adult cohort of 338 patients with biopsy-proven FSGS with long-term follow-up in the era of RAAS inhibition using data from the US Department of Defense health care network. Results Multivariate analysis showed that nephrotic-range proteinuria (NRP), eGFR <60 ml/min per 1.73 m2, hypoalbuminemia, interstitial fibrosis and tubular atrophy, and interstitial inflammation at diagnosis and the absence of remission were all associated with worse long-term renal survival. IgM, C3, and a combination of IgM/C3 immunofluorescence staining were not associated with reduced renal survival. IST was not associated with improved renal survival in the whole cohort, or in a subgroup with NRP. However, IST was associated with better renal survival in a subgroup of patients with FSGS with both NRP and hypoalbuminemia and hypoalbuminemia alone. Conclusions Our study suggests that IST should be reserved for patients with FSGS and nephrotic syndrome. It also introduces interstitial inflammation as a potential risk factor for ESKD and does not support the proposed pathogenicity of IgM and complement activation.
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Affiliation(s)
- Benjamin M. Forster
- Walter Reed National Military Medical Center, Nephrology Department, Bethesda, Maryland
| | - Robert Nee
- Walter Reed National Military Medical Center, Nephrology Department, Bethesda, Maryland
| | - Dustin J. Little
- Walter Reed National Military Medical Center, Nephrology Department and Late Development, Cardiovascular, Renal and Metabolism BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | - Peter J. Greasley
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - James B. Hughes
- Walter Reed National Military Medical Center, Nephrology Department, Bethesda, Maryland
| | - Sarah M. Gordon
- Tripler Army Medical Center, Nephrology Department, Honolulu, Hawaii
| | - Stephen W. Olson
- Walter Reed National Military Medical Center, Nephrology Department, Bethesda, Maryland
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