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Cetinkaya H, Gursu M, Yazici H, Cebeci E, Eren N, Altiparmak MR, Akcay OF, Sahin G, Dheir H, Basturk T, Atilgan KG, Aydemir N, Turgutalp K, Yilmaz M, Sirali SK, Tatar E, Boz EG, Mirioglu S, Kazan S, Aydin E, Aydin Z, Turkmen K, Kutlay S, Karagoz F, Ogutmen MB, Ozturk S, Ozkan O, Yildiz N, Dincer T, Yasar E, Gok M, Turkmen A, Dede F, Derici U. Could mesangial C3 deposition be an independent prognostic marker in immunoglobulin A nephropathy? J Nephrol 2024; 37:923-932. [PMID: 37947938 DOI: 10.1007/s40620-023-01770-1] [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: 04/11/2023] [Accepted: 08/18/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Immunoglobulin A nephropathy (IgAN) is a common primary glomerulonephropathy. There is evidence that mesangial C3 deposition plays a role in the development of the disease. The aim of this study was to examine the effect of C3 deposition on the prognosis of IgAN patients. METHOD The study included 1135 patients with biopsy-confirmed IgAN from the database of the Turkish Nephrology Association Glomerular Diseases Working Group (TSN-GOLD). Patients were excluded from the study if they were aged < 18 or > 75 years or if C3 staining had not been performed in the immunofluorescent analysis. C3 deposition was defined as an immunofluorescence intensity of C3 ≥ 2 + within the mesangium. The primary endpoints were the development of end-stage renal disease, a 30% decrease in glomerular filtration rate compared to the basal value or an elevation in proteinuria to a nephrotic level (3.5 gr/day). RESULTS Mesangial C3 deposition was observed in 603 (53.1%) patients. No statistically significant difference was found at baseline between the groups with and without mesangial C3 deposition, as for age, sex, BMI, proteinuria level, or the presence of hypertension. In the follow-up period with a mean duration of 78 months, no significant difference was found between the two groups regarding the primary endpoints (p = 0.43). A significant correlation between C3 deposition and segmental glomerulosclerosis (S1) according to the Oxford MEST-C classification was found (p = 0.001). CONCLUSION Although a correlation was observed between mesangial C3 deposition and the S1 MEST-C classification, mesangial C3 deposition was not a prognostic factor in IgAN.
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Affiliation(s)
- Hakki Cetinkaya
- Department of Nephrology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Meltem Gursu
- Medical Faculty, Nephrology, Bezmialem Vakif University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey
| | - Egemen Cebeci
- Department of Nephrology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Necmi Eren
- Medical Faculty, Nephrology, Kocaeli University, Izmit, Kocaeli, Turkey
| | | | | | - Gulizar Sahin
- Department of Nephrology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hamad Dheir
- Medical Faculty, Nephrology, Sakarya University, Adapazari, Sakarya, Turkey
| | - Taner Basturk
- Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kadir Gokhan Atilgan
- Department of Nephrology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nihal Aydemir
- Department of Nephrology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Kenan Turgutalp
- Division of Nephrology, Department of Internal Medicine, Mersin University School of Medicine, Mersin, Turkey
| | - Murvet Yilmaz
- Department of Nephrology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semahat Karahisar Sirali
- Department of Nephrology, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Erhan Tatar
- Department of Nephrology, Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Elif Gullulu Boz
- Division of Nephrology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Safak Mirioglu
- Medical Faculty, Nephrology, Bezmialem Vakif University, Istanbul, Turkey
| | - Sinan Kazan
- Department of Nephrology, Afyonkarahisar School of Medicine, University of Health Sciences, Afyonkarahisar, Turkey
| | - Emre Aydin
- Medical Faculty, Nephrology, Dicle University, Diyarbakir, Turkey
| | - Zeki Aydin
- Department of Nephrology, Darica Farabi Training and Research Hospital, University of Health Sciences, Darica, Kocaeli, Turkey
| | - Kultigin Turkmen
- Meram Medical Faculty, Nephrology, Necmettin Erbakan University, Konya, Turkey
| | - Sim Kutlay
- Medical Faculty, Nephrology, Ankara University, Ankara, Turkey
| | - Ferdi Karagoz
- Medical Faculty, Nephrology, Trakya University, Edirne, Turkey
| | - Melike Betul Ogutmen
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Savas Ozturk
- Istanbul Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey
| | - Oktay Ozkan
- Department of Nephrology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nuriye Yildiz
- Medical Faculty, Nephrology, Kocaeli University, Izmit, Kocaeli, Turkey
| | - Tamer Dincer
- Cerrahpasa Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey
| | - Emre Yasar
- Medical Faculty, Nephrology, Gazi University, Ankara, Turkey
| | - Mahmut Gok
- Department of Nephrology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aydın Turkmen
- Istanbul Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey
| | - Fatih Dede
- Department of Nephrology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Ulver Derici
- Medical Faculty, Nephrology, Gazi University, Ankara, Turkey
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2
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Delanghe JR, Delrue C, Speeckaert R, Speeckaert MM. The potential role of vitamin D binding protein in kidney disease: a comprehensive review. Acta Clin Belg 2024; 79:130-142. [PMID: 38166537 DOI: 10.1080/17843286.2023.2301278] [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: 11/12/2023] [Accepted: 12/30/2023] [Indexed: 01/04/2024]
Abstract
Chronic kidney disease (CKD) is a growing health concern with a complex etiological landscape. Among the numerous factors implicated, vitamin D binding protein (VDBP) has emerged as a focal point of scientific studies because of its critical role in vitamin D metabolism and immune modulation. The relationship between VDBP and CKD reveals a complex web of molecular and biochemical details that have great potential for improving diagnostic understanding and treatment strategies for CKD. This review summarizes the multifaceted roles of VDBP, including its molecular dynamics, interactions with vitamin D, and subsequent implications for kidney function. The main focus of the discussion is how VDBP affects bone mineral homeostasis, highlighted by the dysregulation of calcium and phosphorus metabolism, which is a part of the pathophysiology of CKD. The discussion also touches on the immunomodulatory scope of VDBP and how it may reduce the chronic inflammatory environment that accompanies CKD. The diagnostic potential of VDBP as a biomarker for CKD has been rigorously examined, highlighting its capacity to improve early detection and prognostic assessment. Modification of VDBP activity has the potential to slow the course of CKD and improve patient outcomes. Furthermore, a detailed examination of the genetic polymorphisms of VDBP and their implications for CKD susceptibility and treatment responsiveness provides a perspective for personalized medical methods. Prospects for the future depend on the expansion of studies that try to understand the molecular mechanisms underlying the VDBP-CKD interaction, in addition to clinical trials that evaluate the effectiveness of VDBP-focused treatment approaches.
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Affiliation(s)
- Joris R Delanghe
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Charlotte Delrue
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | | | - Marijn M Speeckaert
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
- Research Foundation-Flanders (FWO), Ghent University Hospital, Brussels, Belgium
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3
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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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4
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Abstract
The complement cascade comprises soluble and cell surface proteins and is an important arm of the innate immune system. Once activated, the complement system rapidly generates large quantities of protein fragments that are potent mediators of inflammatory, vasoactive and metabolic responses. Although complement is crucial to host defence and homeostasis, its inappropriate or uncontrolled activation can also drive tissue injury. For example, the complement system has been known for more than 50 years to be activated by glomerular immune complexes and to contribute to autoimmune kidney disease. Notably, the latest research shows that complement is also activated in kidney diseases that are not traditionally thought of as immune-mediated, including haemolytic-uraemic syndrome, diabetic kidney disease and focal segmental glomerulosclerosis. Several complement-targeted drugs have been approved for the treatment of kidney disease, and additional anti-complement agents are being investigated in clinical trials. These drugs are categorically different from other immunosuppressive agents and target pathological processes that are not effectively inhibited by other classes of immunosuppressants. The development of these new drugs might therefore have considerable benefits in the treatment of kidney disease.
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Affiliation(s)
- Vojtech Petr
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joshua M Thurman
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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Hu Y, Huang Z, Cao Q, Chen B, Xu S, Qiu W, You X, Zhang J, Chen C. Clinical significance of massive proteinuria in primary IgA nephropathy with and without nephrotic syndrome: a single center cohort study. Ren Fail 2023; 45:2267138. [PMID: 37850851 PMCID: PMC10586089 DOI: 10.1080/0886022x.2023.2267138] [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: 04/24/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Both primary IgA nephropathy (IgAN) with and without nephrotic syndrome (NS) can present massive proteinuria (24-h urinary protein ≥3.5 g/d). The clinical significance of massive proteinuria may be different in the two entities and needs further research. METHODS Data of 1870 patients with biopsy-proven IgAN in our hospital from January 2011 to December 2022 was retrospectively reviewed. A total of 242 IgAN patients with massive proteinuria were enrolled. Patients who presented with nephrotic syndrome at renal biopsy were included in the IgAN with NS cohort (IgAN-NS). The IgAN with nephrotic-range proteinuria cohort (IgAN-NR) consisted of 1:1 matched cases from the remaining according to age, gender, estimated glomerular filtration rate (eGFR) at baseline, and follow-up time. The clinical and pathological characteristics between the two cohorts were analyzed. RESULTS The IgAN-NS had a significantly higher proteinuria level than the IgAN-NR (p < .001). Cluster analysis revealed that proteinuria was associated with lipids in IgAN-NS, while it was associated with inflammatory indicators in IgAN-NR. When the complete remission of proteinuria (CR) was not achieved, the Kaplan-Meier analysis showed the prognosis of IgAN-NS was significantly worse than that of IgAN-NR (p = .04). Then, our GLMM model and line chart showed that the serum albumin level of the IgAN-NR was always evidently higher than that of the IgAN-NS while the significant difference in urinary albumin/creatinine ratio between the two cohorts gradually disappeared during the short-term follow-up (1 year). Moreover, the Cox regression analysis showed that the increased serum albumin was an independent protective factor for the poor outcomes (eGFR decreased from the baseline ≥ 30% continuously or reached end-stage renal disease [ESRD]). CONCLUSION The IgAN-NS had poorer clinicopathologic manifestation than IgAN-NR, including severer massive proteinuria. When the CR was not achieved, the prognosis of IgAN-NS was inferior to that of the IgAN-NR.
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Affiliation(s)
- Ya Hu
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Ziyuan Huang
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Qianqian Cao
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Bo Chen
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Shungang Xu
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Wenxian Qiu
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Xiaohan You
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Ji Zhang
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Chaosheng Chen
- Department of Nephrology, The First Affifiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
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Tesař V, Radhakrishnan J, Charu V, Barratt J. Challenges in IgA Nephropathy Management: An Era of Complement Inhibition. Kidney Int Rep 2023; 8:1730-1740. [PMID: 37705895 PMCID: PMC10496078 DOI: 10.1016/j.ekir.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023] Open
Abstract
IgA nephropathy (IgAN) is the most common glomerular disease worldwide, with an estimated annual incidence of 25 per million adults. Despite optimized supportive care, some patients fail to achieve disease control and suffer progressive deterioration of kidney function. In this subpopulation of patients, the Kidney Disease: Improving Global Outcomes 2021 guidelines recommend consideration of corticosteroids; however, their use is associated with significant side effects. Ongoing clinical trials are expected to identify corticosteroid-sparing therapies to help improve treatment and prognosis for patients with IgAN. It has been well-documented that the complement system plays a significant role in IgAN pathogenesis, and several complement inhibitors are now entering late-stage clinical development. This review evaluates what we know about the role of complement in the pathophysiology of IgAN and considers how the availability of targeted complement inhibitors may impact future clinical practice. Key knowledge gaps are evaluated, and research opportunities are recommended to help guide clinical decision-making and optimize patient outcomes. Such gaps include evaluating the relative contribution of the alternative and lectin pathways to disease pathogenesis, and the importance of determining the dominant pathway driving IgAN progression. Continued research into the staining of complement proteins in kidney biopsies and identifying targeted biomarkers to assess disease progression and treatment responses will also be needed to support the implementation of newer therapies in clinical practice. Considering the future horizons for enhancing the care of patients with IgAN, tackling the outstanding challenges now will help prepare for the best possible future outcomes.
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Affiliation(s)
- Vladimir Tesař
- Department of Nephrology, Charles University, Prague, Czech Republic
| | | | - Vivek Charu
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Wang S, Dong L, Qin A, Tan J, Zhou X, Qin W. Roles of mesangial C3 and C1q deposition in the clinical manifestations and prognosis of IgAN. Int Immunopharmacol 2023; 120:110354. [PMID: 37235963 DOI: 10.1016/j.intimp.2023.110354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND AIM Immunoglobulin A nephropathy (IgAN) is regarded as the most common type of glomerulonephritis around the world and has the potential to result in renal failure. Complement activation has been addressed by a great body of evidence in the pathogenesis of IgAN. We aimed to evaluate the predictive value of C3 and C1q deposition for disease progression in IgAN patients in this retrospective study. METHODS We recruited 1191 biopsy-diagnosed IgAN patients, and they were divided into different groups according to their glomerular immunofluorescence examination of renal biopsy tissues: 1) C3 deposits ≥ 2 + group (N = 518) and C3 deposits < 2 + group (N = 673). 2) C1q deposit-positive group (N = 109) and C1q deposit-negative group (N = 1082). The renal outcomes were end-stage renal disease (ESRD) and/or an estimated glomerular filtration rate (eGFR) decrease greater than 50% from the baseline value. Kaplan-Meier analyses were performed to evaluate renal survival. Univariate and multivariate Cox proportional hazard regression models were used to evaluate the effect of C3 and C1q deposition on renal outcome in IgAN patients. In addition, we compared the predictive value of mesangial C3 and C1q deposition in IgAN patients. RESULTS The median follow-up period was 53 months (interquartile range 36-75 months). During follow-up, 7% (84) of patients progressed to ESRD, and 9% (111) of patients had an eGFR decline ≥ 50%. IgAN patients complicated with C3 deposits ≥ 2 + were associated with more severe renal dysfunction and pathologic lesions at the time of renal biopsy. The crude incidence rates for the endpoint were 12.5% (84 out of 673) and 17.2% (89 out of 518) in the C3 < 2 + and C3 ≥ 2 + groups, respectively (P = 0.022). Of C1q deposit-positive and C1q deposit-negative patients, 22.9% (25 out of 109) and 13.7% (148 out of 1082) reached the composite endpoint, respectively (P = 0.009). Adding C3 deposition to clinical and pathologic models had better predictability of renal disease progression than C1q. CONCLUSION Glomerular C3 and C1q deposits affected the clinicopathologic features of IgAN patients and emerged as independent predictors and risk factors for renal outcomes. In particular, the predictive ability of C3 was slightly better than that of C1q.
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Affiliation(s)
- Siqing Wang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lingqiu Dong
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Aiya Qin
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiaxing Tan
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyuan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Qin
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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8
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Zhang J, Huang Z, Lin S, Hu Y, Liang Y, Qiu W, Chen B, Chen C. Clinicopathological and prognostic study of primary IgA nephropathy with light chain λ restriction in the mesangial deposits. Kidney Int Rep 2022; 7:776-785. [PMID: 35497802 PMCID: PMC9039423 DOI: 10.1016/j.ekir.2022.01.1053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Primary IgA nephropathy (IgAN) with light chain λ restriction in the mesangial deposits (IgAN-λ) has unique immunofluorescence (IF) features. Nevertheless, its clinicopathology and prognosis are still ambiguous. Methods From January 2002 to December 2020, the clinical and pathologic data of 3872 patients who were diagnosed with having primary IgAN by renal biopsy in our hospital were reviewed. A total of 187 patients who met the selection criteria for IgAN-λ were enrolled to conduct a retrospective single-center study. The selection criteria were that IF features conform to light chain λ restriction in the mesangial deposits. According to age, sex, renal function (estimated glomerular filtration rate [eGFR]), and follow-up time, the control group was constructed with 1:3 matched cases of IgAN. The clinicopathologic and prognostic differences between the 2 groups were analyzed. Results Compared with that in the IgAN group, the serum fibrinogen level in the IgAN-λ group was significantly higher (P < 0.001). Furthermore, cluster analysis indicated the different clusters involved in fibrinogen between the IgAN-λ and IgAN groups and that fibrinogen is associated with factors reflecting renal function in IgAN-λ but proteinuria levels in IgAN. The light chain λ deposit in the mesangium is associated with the formation of crescents in those with IgAN-λ, but complement C3 deposition in those with IgAN. Our Kaplan-Meier analysis revealed that the prognosis of the IgAN-λ group was significantly worse than that of the IgAN group within >6 years of follow-up (P = 0.02). The multi-Cox analysis revealed that the light chain λ restriction in the mesangial deposits was an independent risk factor for poor outcomes (eGFR decreased from the baseline ≥ 30% continuously or reached end-stage renal disease [ESRD] or died). Conclusion The prognosis of those with IgAN-λ was worse than that of those with IgAN, which may be attributed to the light chain λ restriction in the mesangial deposits inducing a significant systemic inflammation manifested as severe clinical features and frequent crescent.
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Affiliation(s)
- Ji Zhang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Ziyuan Huang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Sishi Lin
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Ya Hu
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Yan Liang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Wenxian Qiu
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Bo Chen
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Correspondence: Bo Chen or Chaosheng Chen, Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou 325000, Zhejiang, PR China.
| | - Chaosheng Chen
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
- Correspondence: Bo Chen or Chaosheng Chen, Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou 325000, Zhejiang, PR China.
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Mizerska-Wasiak M, Such-Gruchot A, Cichoń-Kawa K, Turczyn A, Małdyk J, Miklaszewska M, Drożdż D, Firszt-Adamczyk A, Stankiewicz R, Rybi-Szumińska A, Wasilewska A, Szczepańska M, Bieniaś B, Sikora P, Pukajło-Marczyk A, Zwolińska D, Pawlak-Bratkowska M, Tkaczyk M, Zachwieja J, Drożyńska-Duklas M, Żurowska A, Gadomska-Prokop K, Grenda R, Pańczyk-Tomaszewska M. The Role of Complement Component C3 Activation in the Clinical Presentation and Prognosis of IgA Nephropathy-A National Study in Children. J Clin Med 2021; 10:jcm10194405. [PMID: 34640422 PMCID: PMC8509710 DOI: 10.3390/jcm10194405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to evaluate the influence of the intensity of mesangial C3 deposits in kidney biopsy and the serum C3 level on the clinical course and outcomes of IgAN in children. The study included 148 children from the Polish Pediatric IgAN Registry, diagnosed based on kidney biopsy. Proteinuria, creatinine, IgA, C3 were evaluated twice in the study group, at baseline and the end of follow-up. Kidney biopsy was categorized using the Oxford classification, with a calculation of the MEST-C score. The intensity of IgA and C3 deposits were rated from 0 to +4 in immunofluorescence microscopy. The intensity of mesangial C3 > +1 deposits in kidney biopsy has an effect on renal survival with normal GFR in children with IgAN. A reduced serum C3 level has not been a prognostic factor in children but perhaps this finding should be confirmed in a larger group of children.
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Affiliation(s)
- Małgorzata Mizerska-Wasiak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
- Correspondence:
| | - Agnieszka Such-Gruchot
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
| | - Karolina Cichoń-Kawa
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
| | - Agnieszka Turczyn
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
| | - Jadwiga Małdyk
- Department of Pathology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, 30-663 Cracow, Poland; (M.M.); (D.D.)
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, 30-663 Cracow, Poland; (M.M.); (D.D.)
| | - Agnieszka Firszt-Adamczyk
- Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, 87-100 Torun, Poland; (A.F.-A.); (R.S.)
| | - Roman Stankiewicz
- Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, 87-100 Torun, Poland; (A.F.-A.); (R.S.)
| | - Agnieszka Rybi-Szumińska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-089 Bialystok, Poland; (A.R.-S.); (A.W.)
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-089 Bialystok, Poland; (A.R.-S.); (A.W.)
| | - Maria Szczepańska
- Department of Pediatrics, SMDZ in Zabrze, Silesian Medical University, 41-808 Zabrze, Poland;
| | - Beata Bieniaś
- Department of Pediatric Nephrology, Medical University of Lublin, 20-059 Lublin, Poland; (B.B.); (P.S.)
| | - Przemysław Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, 20-059 Lublin, Poland; (B.B.); (P.S.)
| | - Agnieszka Pukajło-Marczyk
- Department of Pediatric Nephrology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-M.); (D.Z.)
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-M.); (D.Z.)
| | - Monika Pawlak-Bratkowska
- Department of Pediatrics, Immunology and Nephrology, Polish Mothers Memorial Hospital Research Institute, 93-338 Lodz, Poland; (M.P.-B.); (M.T.)
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mothers Memorial Hospital Research Institute, 93-338 Lodz, Poland; (M.P.-B.); (M.T.)
| | - Jacek Zachwieja
- Department of Pediatric Nephrology and Dialysis, Medical University of Poznan, 61-701 Poznan, Poland;
| | - Magdalena Drożyńska-Duklas
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.D.-D.); (A.Ż.)
| | - Aleksandra Żurowska
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.D.-D.); (A.Ż.)
| | - Katarzyna Gadomska-Prokop
- Department of Nephrology, Kidney Transplantation and Hypertension, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (K.G.-P.); (R.G.)
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Hypertension, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (K.G.-P.); (R.G.)
| | - Małgorzata Pańczyk-Tomaszewska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
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