Activation of the alternative complement pathway predicts renal outcome in patients with lupus nephritis
Activation of the alternative complement pathway predicts renal outcome in patients with lupus nephritis
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DOI：
10.1177/0961203320925165
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发表时间：
2020-05-14
期刊：
影响因子：
2.6
通讯作者：
Kim, Jinseok
中科院分区：
文献类型：
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作者：
Kim, Hyunwoo;Kim, Taehee;Kim, Jinseok
ObjectivesThe的目的，这项研究的目的是澄清激活补体途径的狼疮肾炎（LN）患者，并阐明这些补体激活类型和临床outcomes.MethodsWe之间的关联入组115例活检证实LN从2003年至2016年从狼疮队列釜山白医院和韩国济州国立大学医院。根据肾小球补体沉积模式将患者分为两组。肾小球中C1 q、C4和/或C3沉积物的存在被认为是经典途径激活伴或不伴旁路途径激活的证据（组1，N = 93），而无C1 q和C4沉积物的肾小球C3沉积被认为是旁路途径限制性激活的标志物（组2，N = 22）。研究终点为肾脏疾病进展，定义为肾小球滤过率估计值较基线值下降≥ 50%或进展为终末期肾病。结果患者的肾小球滤过率估计值平均为85.7 ± 32.4 mL/min/1.73 m2，尿蛋白/肌酐比值中位数为3.1 g/g，在肾脏活检的时候。49例患者（43%）有肾病范围的蛋白尿。与第1组患者相比，第2组患者年龄更大，更可能是男性，高血压更严重。此外，第1组患者的血浆C3和C4水平显著低于第2组患者。此外，第1组患者的抗dsDNA浓度显著高于第2组患者。平均随访时间为5.4 ± 3.4年。与第1组患者相比，第2组患者对一年免疫抑制治疗的应答率较差。在后续的时间，肾脏疾病的进展是显着高于组2比组1 patients.ConclusionThis研究表明，有替代补体途径限制激活在肾组织中的一小部分LN患者，这些患者有更糟糕的肾脏结果相比，肾小球经典补体途径激活或不替代途径激活的患者。
ObjectivesThe aims of this study were to clarify the activation of complement pathways in patients with lupus nephritis (LN), and to elucidate the association between these complement activation types and clinical outcomes.MethodsWe enrolled 115 patients with biopsy-proven LN from 2003 to 2016 from the lupus cohort at the Busan Paik Hospital and the Jeju National University Hospital in Korea. The patients were divided into two groups based on the patterns of glomerular complements deposits. The presence of C1q, C4 and/or C3 deposits in the glomerulus was considered evidence for the activation of the classical pathway with or without alternative pathway activation (group 1, N = 93), and glomerular C3 deposition without C1q and C4 deposits was considered as a marker for the alternative pathway limited activation (group 2, N = 22). The study end point was progression of kidney disease defined as a >= 50% reduction in estimated glomerular filtration rate from baseline values or advancement to end-stage renal disease.ResultsThe mean estimated glomerular filtration rate and median urine protein-to-creatinine ratio of the patients were 85.7 +/- 32.4 mL/min/1.73 m(2) and 3.1 g/g, respectively, at the time of kidney biopsy. Forty-nine patients (43%) had nephrotic range of proteinuria. Compared to group 1 patients, those in group 2 were older, were more likely to be males and were more hypertensive. In addition, plasma C3 and C4 levels were significantly lower in group 1 patients compared to those in group 2. Moreover, anti-dsDNA concentration was significantly higher in group 1 patients compared to those in group 2. The mean follow-up time was 5.4 +/- 3.4 years. The rates of response to one-year immunosuppressive treatment were poorer in group 2 patients compared to those in group 1. During the follow-up time, the progression of kidney disease was significantly higher in group 2 than in group 1 patients.ConclusionThis study showed that there was alternative complement pathway limited activation in the renal tissue in a small number of patients with LN, and these patients had worse renal outcomes compared to patients with glomerular classical complement pathway activation with or without alternative pathway activation.