Mesangial C4d deposition may predict progression of kidney disease in pediatric patients with IgA nephropathy.
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Date
2017
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Abstract
Background Data on the risk factors for chronic kidney disease
in children with immunoglobulin A nephropathy (IgAN)
are scarce. This study was aimed at investigating whether
glomerular C4d immunostaining is a prognostic marker in
pediatric IgAN.
Methods In this retrospective cohort study, 47 patients with
IgAN biopsied from 1982 to 2010 were evaluated.
Immunohistochemistry for C4d was performed in all cases.
For analysis, patients were grouped according to positivity
or not for C4d in the mesangial area. Primary outcome was a
decline in baseline estimated glomerular filtration rate (eGFR)
by 50% or more.
Results Median follow-up was 8.3 years. Median renal survival
was 13.7 years and the probability of a 50% decline in
eGFR was 13% over 10 years. Nine children exhibited the
primary outcome and 4 developed end-stage renal disease
(ESRD). Compared with C4d-negative patients (n = 10),
C4d-positive patients (n = 37) presented higher baseline proteinuria
(1.66 ± 0.68 vs 0.47 ± 0.19 g/day/1.73 m2, p < 0.001),
a progressive decline in eGFR (−10.04 ± 19.38 vs 1.70 ±
18.51 ml/min/1.73 m2/year; p = 0.045), and more frequently
achieved the primary outcome (50.0 vs 10.8%, p = 0.013), and
ESRD (30.0 vs 2.7%, p = 0.026). No difference was observed
in Oxford classification variables. Baseline proteinuria,
endocapillary hypercellularity and mesangial C4d deposition
were associated with primary outcome in univariate analysis.
Proteinuria and mesangial C4d deposition at baseline independently
predicted the decline in eGFR. Renal survival was significantly
reduced in C4d-positive patients (8.6 vs 15.1 years
in C4d-negative patients, p < 0.001).
Conclusions In this exclusively pediatric cohort, positivity for
C4d in the mesangial area was an independent predictor of
renal function deterioration in IgAN.
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Keywords
Glomerulonephritis, Chronic kidney disease, C4d staining, Proteinuria, Renal function
Citation
FABIANO, R. C. G. et al. Mesangial C4d deposition may predict progression of kidney disease in pediatric patients with IgA nephropathy. Pediatric Nephrology, v. 32, p. 1211-1220, 2017. Disponível em: <https://link.springer.com/article/10.1007%2Fs00467-017-3610-y>. Acesso em: 29 ago. 2017.