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Liu MC, Li JL, Wang YF, Meng Y, Zheng GM, Cai Z, Shen C, Wang MD, Zhu XG, Chen YZ, Wang YL, Zhao WJ, Niu WQ, Wang YX. Association between serum complements and kidney function in patients with diabetic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1195966. [PMID: 38047115 PMCID: PMC10690951 DOI: 10.3389/fendo.2023.1195966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Objective We aimed to explore the association between serum complements and kidney function of diabetic kidney disease (DKD) in Chinese patients. Methods This is a retrospective study involving 2,441 participants. DKD was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) categories. Participants were classified as stages G1-G5 by KDIGO glomerular filtration rate (GFR) categories. Effect sizes are expressed as odds ratio (OR) with 95% confidence interval (CI). Results After balancing age, gender, systolic blood pressure (SBP), hemoglobin A1c (HbA1C), serum triglyceride (TG), and urinary albumin-to-creatinine ratio (UACR) between the G2-G5 and control groups, per 0.1 g/L increment in serum complement C3 was significantly associated with a 27.8% reduced risk of DKD at G5 stage (OR, 95% CI, P: 0.722, 0.616-0.847, <0.001) relative to the G1 stage. Conversely, per 0.1 g/L increment in serum complement C4 was associated with an 83.0-177.6% increased risk of G2-G5 stage (P<0.001). Serum complement C1q was not statistically significant compared to controls at all stages prior to or after propensity score matching. Conclusions Our results indicate that high concentrations of serum C4 were associated with the significantly elevated risk of kidney function deterioration across all stages, and reduced serum C3 levels with an increased risk of DKD stage G5.
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Affiliation(s)
- Meng-chao Liu
- The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jia-lin Li
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yue-fen Wang
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yuan Meng
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Gui-min Zheng
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Zhen Cai
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Cun Shen
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Meng-di Wang
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xiang-gang Zhu
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yang-zi Chen
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yu-lin Wang
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wen-jing Zhao
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wen-quan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Yao-xian Wang
- The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Henan University of Chinese Medicine, Zhengzhou, China
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Zhou J, Sun S, Zhang D, Mao J, Xiao H, Yao Y, Wang F, Yu L, Liu L, Feng C, Li C, Su B, Zhang H, Liu X, Xu K, Ju W, Zhong X, Ding J. Urinary epidermal growth factor predicts complete remission of proteinuria in Chinese children with IgA nephropathy. Pediatr Res 2023. [PMID: 36864281 PMCID: PMC10382307 DOI: 10.1038/s41390-023-02542-0] [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] [Indexed: 03/04/2023]
Abstract
BACKGROUND This study investigated the association between urinary epidermal growth factor (EGF) and complete remission (CR) of proteinuria in children with IgA nephropathy (IgAN). METHODS We included 108 patients from the Registry of IgA Nephropathy in Chinese Children. The urinary EGF at the baseline and follow-up were measured and normalized by urine creatinine (expressed as uEGF/Cr). The person-specific uEGF/Cr slopes were estimated using linear mixed-effects models for the subset of patients with longitudinal data of uEGF/Cr. Cox models were used to analyze the associations of baseline uEGF/Cr and uEGF/Cr slope with CR of proteinuria. RESULTS Patients with high baseline uEGF/Cr were more likely to achieve CR of proteinuria (adjusted HR 2.24, 95% CI: 1.05-4.79). The addition of high baseline uEGF/Cr on the traditional parameters significantly improved the model fit for predicting CR of proteinuria. In the subset of patients with longitudinal data of uEGF/Cr, high uEGF/Cr slope was associated with a higher likelihood of CR of proteinuria (adjusted HR 4.03, 95% CI: 1.02-15.88). CONCLUSIONS Urinary EGF may be a useful noninvasive biomarker for predicting and monitoring CR of proteinuria in children with IgAN. IMPACT High levels of baseline uEGF/Cr (>21.45 ng/mg) could serve as an independent predictor for CR of proteinuria. The addition of baseline uEGF/Cr on the traditional clinical pathological parameters significantly improved the fitting ability for the prediction of CR of proteinuria. Longitudinal data of uEGF/Cr were also independently associated with CR of proteinuria. Our study provides evidence that urinary EGF may be a useful noninvasive biomarker in the prediction of CR of proteinuria as well as monitoring therapeutic response, thus guiding treatment strategies in clinical practice for children with IgAN.
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Affiliation(s)
- Jianmei Zhou
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Shuzhen Sun
- Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dongfeng Zhang
- Division of Nephrology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jianhua Mao
- Division of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Huijie Xiao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yong Yao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Lichun Yu
- Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ling Liu
- Division of Nephrology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Chunyue Feng
- Division of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Baige Su
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hongwen Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoyu Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ke Xu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Wenjun Ju
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
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Ji FP, Wen L, Zhang YP, Liu EP, Wen JG. Serum complement factor B is associated with disease activity and progression of idiopathic membranous nephropathy concomitant with IgA nephropathy. Int Urol Nephrol 2021; 54:1287-1294. [PMID: 34585312 DOI: 10.1007/s11255-021-02997-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Few studies have reported the roles of the complement system in concomitant idiopathic membranous nephropathy and IgA nephropathy (IMN-IgAN). Complement factor B (CFB) is a crucial factor that involved in the alternative complement pathway. We aimed to evaluate the association between disease activity (eGFR, anti-PLA2R antibody levels and 24 h urinary protein excretion), progression and serum CFB levels of IMN-IgAN patients. METHODS In total, 39 IMN-IgAN patients (median follow-up, 46.6 months), 99 IMN patients and 92 IgAN patients participated in this study. The disease progression event was defined as end-stage renal disease (ESRD) or a 30% decline in estimated glomerular filtration rate (eGFR). The serum CFB concentration was measured by enzyme-linked immunosorbent assay. RESULTS Serum CFB levels were lower in IMN-IgAN patients than in patients with IgAN only (P < .001). Serum CFB levels correlated positively with serum creatinine levels, anti-PLA2R antibody levels and 24 h urinary protein excretion (P < .05). Kaplan-Meier analysis revealed that IMN-IgAN patients with high serum CFB levels had a significantly lower cumulative renal survival rate than patients with low levels (log-rank test, P = .009). Multivariate Cox regression analysis showed that high baseline serum CFB levels were significantly associated with poor renal outcome in patients with IMN-IgAN (HR: 2.727, 95% CI 1.076-6.913, P = .034). CONCLUSION High serum CFB levels correlated with increased serum creatinine, anti-PLA2R antibody and urinary protein excretion as well as poor renal prognosis in patients with IMN-IgAN, indicating that serum CFB may be a marker of disease activity and progression.
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Affiliation(s)
- Feng Ping Ji
- Pediatric Urodynamic Centre, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Department of Urology, First Affiliated Hospital of Zhengzhou University, Jianshe East Road No.1, Zhengzhou, 450052, China
| | - Lu Wen
- Department of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yan Ping Zhang
- Pediatric Urodynamic Centre, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Department of Urology, First Affiliated Hospital of Zhengzhou University, Jianshe East Road No.1, Zhengzhou, 450052, China
| | - Er Peng Liu
- Pediatric Urodynamic Centre, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Department of Urology, First Affiliated Hospital of Zhengzhou University, Jianshe East Road No.1, Zhengzhou, 450052, China
| | - Jian Guo Wen
- Pediatric Urodynamic Centre, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. .,Department of Urology, First Affiliated Hospital of Zhengzhou University, Jianshe East Road No.1, Zhengzhou, 450052, China.
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4
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Wu F, Zhang Y, Cui W, Dong Y, Geng Y, Liu C, Li Z, Xie Y, Cai X, Shang J, Xiao J, Zhao Z. Development and validation of a discrimination model between primary PLA2R-negative membranous nephropathy and minimal change disease confirmed by renal biopsy. Sci Rep 2021; 11:18064. [PMID: 34508140 PMCID: PMC8433159 DOI: 10.1038/s41598-021-97517-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
Membranous nephropathy (MN) and minimal change disease (MCD) are two common causes leading to nephrotic syndrome (NS). They have similar clinical features but different treatment strategies and prognoses. M-type phospholipase A2 receptor (PLA2R) is considered as a specific marker of membranous nephropathy. However, its sensitivity is only about 70%. Therefore, there is a lack of effective and noninvasive tools to distinguish PLA2R-negative MN and MCD patients without renal biopsy. A total 949 patients who were pathologically diagnosed as idiopathic MN or MCD were enrolled in this study, including 805 idiopathic MN and 144 MCD. Based on the basic information and laboratory examination of 200 PLA2R-negative MN and 144 MCD, we used a univariate and multivariate logistic regression to select the relevant variables and develop a discrimination model. A novel model including age, albumin, urea, high density lipoprotein, C3 levels and red blood cell count was established for PLA2R-negative MN and MCD. The discrimination model has great differential capability (with an AUC of 0.904 in training group and an AUC of 0.886 in test group) and calibration capability. When testing in all 949 patients, our model also showed good discrimination ability for all idiopathic MN and MCD.
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Affiliation(s)
- Feng Wu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yiding Zhang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Wen Cui
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yijun Dong
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yingyang Geng
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Changhao Liu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zemeng Li
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yandong Xie
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xiaojing Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Jin Shang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China.
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China.
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, People's Republic of China.
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Yan G, Liu G, Tian X, Tian L, Wang H, Ren P, Ma X, Fu R, Chen Z. Establishment of a novel nomogram for the clinically diagnostic prediction of minimal change disease, -a common cause of nephrotic syndrome. BMC Nephrol 2020; 21:396. [PMID: 32928127 PMCID: PMC7490860 DOI: 10.1186/s12882-020-02058-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Minimal change disease (MCD) is one of the major causes of nephrotic syndrome (NS). A confirmed MCD diagnosis mainly depends on renal biopsy at present, which is an invasive procedure with many potential risks. The overall incidence of complications caused by renal biopsy procedures has been reported as approximately 11 and 6.6% outside and within China, respectively. Unfortunately, there is currently no noninvasive procedure or practical classification method for distinguishing MCD from other primary glomerular diseases available. Method A total of 1009 adult patients who underwent renal biopsy between January 2017 and November 2019 were enrolled in this study. Twenty-five parameters extracted from patient demographics, clinical manifestations, and laboratory test results were statistically analysed. LASSO regression analysis was further performed on these parameters. The parameters with the highest area under the curve (AUC) were selected and used to establish a logistic diagnostic prediction model. Results Of the 25 parameters, 14 parameters were significantly different (P < 0.05). MCD patients were mostly younger (36 (22, 55) vs. 41 (28.75, 53)) and male (59% vs. 52%) and had lower levels of diastolic blood pressure (DBP) (79 (71, 85.5) vs. 80 (74, 89)) and IgG (5.42 (3.17, 6.36) vs. 9.38 (6.79, 12.02)) and higher levels of IgM (1.44 (0.96, 1.88) vs. 1.03 (0.71, 1.45)) and IgE (160 (46.7, 982) vs. 47.3 (19, 126)) than those in the non-MCD group. Using the LASSO model, we established a classifier for adults based on four parameters: DBP and the serum levels of IgG, IgM, IgE. We were able to clinically classify adult patients with NS into MCD and non-MCD using this model. The validation accuracy of the logistic regression model was 0.88. A nomogram based on these four classifiers was developed for clinical use that could predict the probability of MCD in adult patients with NS. Conclusions A LASSO model can be used to distinguish MCD from other primary glomerular diseases in adult patients with NS. Combining the model and the nomogram potentially provides a novel and valuable approach for nephrologists to diagnose MCD, avoiding the complications caused by renal biopsy.
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Affiliation(s)
- Gaofei Yan
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710005, China
| | - Guanzhi Liu
- Bone and Joint Surgery Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710005, China
| | - Xuefei Tian
- Department of Internal Medicine, Yale University school of Medicine, New Haven, CT, 06520, USA
| | - Lifang Tian
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710005, China
| | - Hao Wang
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710005, China
| | - Peiyao Ren
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710005, China
| | - Xiaotao Ma
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710005, China
| | - Rongguo Fu
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710005, China
| | - Zhao Chen
- Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710005, China.
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Qi M, Tan B, Wang J, Liao S, Li J, Liu Y, Yin Y. Post-natal Growth Retardation Associated With Impaired Gut Hormone Profiles, Immune and Antioxidant Function in Pigs. Front Endocrinol (Lausanne) 2019; 10:660. [PMID: 31616382 PMCID: PMC6775201 DOI: 10.3389/fendo.2019.00660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022] Open
Abstract
The factors that cause post-natal growth retardation (PGR) in pigs are complicated; however, metabolic and immune system impairment seem to be involved. The purpose of this study was to investigate the changes of blood parameters, hormone profiles, antioxidant capacity, and immune responses in PGR pigs. Blood and small intestinal mucosa samples were collected from 42-days-old PGR and healthy pigs. The results showed that compared with the healthy group, the relative weight of spleen and kidney were greater, but the liver was lighter in PGR pigs (P < 0.05). The PGR pigs had increased serum alanine transaminase, urea nitrogen, blood ammonia, IgG, and complement 4, but decreased glucose and albumin (P < 0.05). The higher levels of serum leptin (LEP) and thyroxin (T4), and the lower levels of insulin-like growth factor-1 (IGF-1), 5-hydroxytryptamine (5-HT), somatostatin (SS), and agouti gene-related protein (AgRP) were observed in PGR pigs (P < 0.05). Consistent with the serum levels of hormones, the mRNA levels of gut hormones and their receptors were also altered in intestinal mucosa from PGR pigs (P < 0.05). The PGR pigs exhibited higher plasma concentrations of interleukin-1β (IL-1β), IL-6, IL-8, and transformed growth factor beta (TGFβ) (P < 0.05). However, the mRNA expressions of several cytokines were lower in the small intestinal mucosa of PGR pigs (P < 0.05). Abnormal antioxidant indexes in serum of PGR pigs were observed, which was in accordance with the reduced mRNA expression of several anti-oxidative genes in the small intestinal mucosa of PGR pigs (P < 0.05). These data demonstrate that an abnormal gut hormone system, immune dysfunction, and decreased antioxidant capacity may contribute to PGR in pigs. These changes could provide a valuable target in the regulation of post-natal growth retardation in animals and humans.
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Affiliation(s)
- Ming Qi
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Bie Tan
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Jing Wang
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
| | - Simeng Liao
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jianjun Li
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
| | - Yanhong Liu
- Department of Animal Science, University of California, Davis, Davis, CA, United States
| | - Yulong Yin
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
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7
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Liu D, You J, Liu Y, Tang X, Tan X, Xia M, Wu L, Chen G, He L, Zhu X, Liu H. Serum immunoglobulin G provides early risk prediction in immunoglobulin A nephropathy. Int Immunopharmacol 2018; 66:13-18. [PMID: 30415190 DOI: 10.1016/j.intimp.2018.10.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Immunoglobulin A (IgA) nephropathy (IgAN) is a common primary glomerular disease that potentially leads to renal failure, risk prediction of declining kidney function is crucial for early clinical management. Immunoglobulin G (IgG) is an important constituent of the immune system and serves as the preferred therapeutic target in human autoimmune diseases. However, its role in the progression of IgAN is unclear. METHODS From May 2009 to April 2014, 455 patients diagnosed with IgAN at the Second Xiangya Hospital were enrolled in this study; the median follow-up was 42.2 months. All subjects were divided into four groups according to IgG level quartiles. The study endpoint was end-stage renal disease (ESRD) or an irreversible 50% estimated glomerular filtration rate (eGFR) reduction. Clinical data and pathological features of renal biopsy specimens were collected. RESULTS Among IgAN patients, serum IgG levels were directly correlated with the levels of serum albumin and serum IgA but reversely correlated with body weight, systolic blood pressure, and serum creatinine and cholesterol levels. According to stratified analysis of serum IgG, the proportions of composite renal endpoints among the enrolled IgAN patients in the serum IgG concentration subgroups 1 (<7.86), 2 (7.86-10.30), 3 (10.31-12.70), and 4 (>12.71 g/l) were 9.6%, 9.2%, 3.7%, and 3.7% respectively. Importantly, cumulative renal survival rates were significantly higher in the patients with increased serum IgG (p = 0.0114). Serum IgG was also predictive of renal survival, with an HR of 0.745 (95% CI, 0.614 to 0.905, p = 0.003) after adjusting for significant factors in the univariate Cox regression and an HR of 0.871 (95% CI, 0.780 to 0.973, p = 0.014) adjusting for traditional risk factors of IgAN. CONCLUSION These findings demonstrate that a decreased serum IgG level at the time of renal biopsy is independently associated with a poor renal outcome in IgAN patients.
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Affiliation(s)
- Di Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Jing You
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Yexin Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Xiaofang Tang
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Xia Tan
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Ming Xia
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Lingzhi Wu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Guochun Chen
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Liyu He
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Xuejing Zhu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China
| | - Hong Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No. 139 Renmin Middle Rd, Changsha 410011, Hunan, China.
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