Mesangial C4d deposition: a new prognostic factor in IgA nephropathy
Mesangial C4d deposition: a new prognostic factor in IgA nephropathy
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DOI：
10.1093/ndt/gfn563
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发表时间：
2009-03-01
影响因子：
6.1
通讯作者：
Aljama, Pedro
中科院分区：
文献类型：
--
作者：
Espinosa, Mario;Ortega, Rosa;Aljama, Pedro
背景。已有研究表明，根据补体激活的模式，IgA肾病患者可分为两组。补体凝集素途径的激活与更严重的肾脏疾病有关。肾小球沉积C4d是补体凝集素途径激活的标志。本研究的目的是确定肾活检时的C4d染色是否可以识别不同长期预后的IgA肾病患者。这项回顾性队列研究包括1992年1月至2006年12月在本中心接受肾活检的所有IgA肾病患者。我们评估了基线年龄、性别、血尿、高血压、血清肌酐和肾小球滤过率（GFR）、尿蛋白、系膜C4d染色、肾小球硬化、间质纤维化和毛细血管外增生。Kaplan-Meier生存和Cox比例风险分析，终末期肾病（ESRD）被定义为透析或移植的开始。C4d阳性19例（32.2%），C4d阴性40例（67.8%）。年龄、高血压、无肉眼血尿、血清肌酐水平、GFR、肾小球硬化、间质纤维化和c4d阳性染色都与ESRD的发展有单一的相关性。c4d阳性患者10年肾脏生存率为43.9%，而c4d阴性患者为90.9% （log-rank, P = 0.0005）。IgA肾病患者肾小球系膜C4d染色阴性有助于鉴别长期预后良好但不需要积极治疗的患者。
Background. It has been shown that patients with IgA nephropathy can be divided into two groups on the basis of the pattern of complement activation. Activation of the lectin pathway of complement is associated with more severe renal disease. Glomerular deposition of C4d is a marker of activation of the lectin pathway of complement. The aim of our study was to determine whether C4d staining at the time of the renal biopsy could identify patients with a different long-term prognosis in IgA nephropathy.Methods. This retrospective cohort study included all patients with IgA nephropathy who underwent renal biopsy at our centre from January 1992 to December 2006. We evaluated baseline age, sex, presence of macroscopic haematuria, hypertension, serum creatinine and glomerular filtration rate (GFR), urine protein, mesangial C4d staining, glomerulosclerosis, interstitial fibrosis and extracapillary proliferation. Kaplan-Meier survival and Cox proportional hazards analyses were performed, with end-stage renal disease (ESRD) being defined as onset of dialysis or transplantation.Results. Nineteen patients (32.2%) were C4d positive and 40 patients (67.8%) C4d negative. Age, hypertension, absence of macroscopic haematuria, serum creatinine levels, GFR, glomerular sclerosis, interstitial fibrosis and C4d-positive staining were all univariately associated with evolution to ESRD. Renal survival at 10 years was 43.9% in C4d-positive patients versus 90.9% in C4d-negative patients (log-rank, P = 0.0005).Conclusion. Negative mesangial C4d staining in glomeruli in patients with IgA nephropathy helps to identify patients with a good long-term prognostic for whom aggressive treatments are not justified.