The relationship between immun staining and progression markers in IgA nephropathy

Yıl 2024, Cilt: 10 Sayı: 2, 187 - 194, 04.03.2024

Semahat Karahisar Şirali , Refika Büberci

https://doi.org/10.18621/eurj.1311453

Öz

Objective: To determine the relationship between immunofluorescence microscopy findings and progression markers at the time of diagnosis in immunoglobulin A (IgA) nephropathy.

Methods: Fifty-two patients with pathological diagnosis of primary IgA nephropathy by showing mesangial and mesangiocapillary IgA-dominant immune deposits in immunofluorescence microscopy were included in the study. At the time of biopsy, biochemical and hematological data, Oxford MEST score and immunofluorescent staining findings were recorded. The serum IgA/C3 ratio was calculated. The immunofluorescence results of the total group were compared with the markers of progression at the time of diagnosis, estimated glomerular filtration rate (eGFR), hematuria, proteinuria, creatinine, and serum IgA/C3 ratio.

Results: The mean age of the study group was 39.9±12.3 years and 55.8% were male. eGFR, albumin, hemoglobin, IgM were significantly lower, and uric acid and hematuria were significantly higher in those with proteinuria above 1 g compared to those with low proteinuria. A positive correlation was found between IgA, C3 and lambda staining and hematuria. There was a positive correlation between C3 staining and creatinine, and a positive correlation with hematuria. A correlation was found between Kappa staining and eGFR.

Conclusion: Correlation was found between IgA, C3 and lambda staining and hematuria at the time of diagnosis in IgA nephropathy.

Anahtar Kelimeler

Immunoglobulin A nephropathy, immunostaining, hematuria

Kaynakça

• 1. McGrogan A, Franssen CF, de Vries CS. The incidence of primary glomerulonephritis worldwide: a systematic review of the literatüre. Nephrol Dial Transplant. 2011 Feb;26(2):414-430. doi: 10.1093/ndt/gfq665.
• 2. Suzuki H, Kiryluk K, Novak J, et al. The pathophysiology of IgA nephropathy. J Am Soc Nephrol. 2011 Oct; 22(10):1795-1803. doi: 10.1681/ASN.2011050464.
• 3. Fabiano RC, Pinheiro SV, Simões E Silva AC. Immunoglobulin A nephropathy: a pathophysiology view. Inflamm Res. 2016 Oct;65(10):757-770. doi: 10.1007/s00011-016-0962-x.
• 4. Rodrigues JC, Haas M, Reich HN. IgA Nephropathy. Clin J Am Soc Nephrol. 2017 Apr 3;12(4):677-686. doi: 10.2215/CJN.07420716.
• 5. Gutiérrez E, Carvaca-Fontán F, Luzardo L, Morales E, Alonso M, Praga M. A personalized update on IgA nephropathy: a new vision and new future challenges. Nephron. 2020;144(11):555-571. doi: 10.1159/000509997.
• 6. Roberts IS. Pathology of IgA nephropathy. Nat Rev Nephrol. 2014 Aug;10(8):445-454. doi: 10.1038/nrneph.2014.92.
• 7. Trimarchi H, Barratt J, Cattran DC, et al; IgAN Classification Working Group of the International IgA Nephropathy Network and the Renal Pathology Society; Conference Participants. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017 May;91(5):1014-1021. doi: 10.1016/j.kint.2017.02.003.
• 8. Wallis R, Mitchell DA, Schmid R, Schwaeble WJ, Keeble AH. Paths reunited: Initiation of the classical and lectin pathways of complement activation. Immunobiology. 2010;215(1):1-11. doi: 10.1016/j.imbio.2009.08.006.
• 9. Schatz-Jakobsen JA, Pedersen DV, Andersen GR. Structural insight into proteolytic activation and regulation of the complement system. Immunol Rev. 2016 Nov;274(1):59-73. doi: 10.1111/imr.12465. PMID: 27782336.
• 10. Guo WY, Zhu L, Meng SJ, et al. Mannose-binding lectin levels could predict prognosis in IgA nephropathy. J Am Soc Nephrol. 2017 Nov;28(11):3175-3181. doi: 10.1681/ASN.2017010076.
• 11. Kim SJ, Koo HM, Lim BJ, et al. Decreased circulating C3 levels and mesangial C3 deposition predict renal outcome in patients with IgA nephropathy. PLoS One. 2012;7(7):e40495. doi: 10.1371/journal.pone.0040495.
• 12. Tortajada A, Gutiérrez E, Goicoechea de Jorge E, et al. Elevated factor H-related protein 1 and factor H pathogenic variants decrease complement regulation in IgA nephropathy. Kidney Int. 2017 Oct;92(4):953-963. doi: 10.1016/j.kint.2017.03.041.
• 13. Pan M, Zhang J, Li Z, et al. Increased C4 and decreased C3 levels are associated with a poor prognosis in patients with immunoglobulin A nephropathy: a retrospective study. BMC Nephrol. 2017 Jul 11;18(1):231. doi: 10.1186/s12882-017-0658-7.
• 14. Gong WY, Liu M, Luo D, et al. High serum IgA/C3 ratio better predicts a diagnosis of IgA nephropathy among primary glomerular nephropathy patients with proteinuria ≤ 1 g/d: an observational cross-sectional study. BMC Nephrol. 2019 Apr 30;20(1):150. doi: 10.1186/s12882-019-1331-0.
• 15. Nam KH, Joo YS, Lee C, et al; Korean GlomeruloNEphritis sTudy (KoGNET) Group. Predictive value of mesangial C3 and C4d deposition in IgA nephropathy. Clin Immunol. 2020 Feb;211:108331. doi: 10.1016/j.clim.2019.108331.
• 16. Wu D, Li X, Yao X, et al. Mesangial C3 deposition and serum C3 levels predict renal outcome in IgA nephropathy. Clin Exp Nephrol. 2021 Jun;25(6):641-651. doi: 10.1007/s10157-021-02034-7.
• 17. Lang Y, Song S, Zhao L, et al. Serum IgA/C3 ratio and glomerular C3 staining predict progression of IgA nephropathy in children. Transl Pediatr. 2021 Mar;10(3):666-672. doi: 10.21037/tp-21-90.
• 18. Selvaskandan H, Shi S, Twaij S, Cheung CK, Barratt J. Monitoring immune responses in IgA nephropathy: biomarkers to guide management. Front Immunol. 2020 Oct 6;11:572754. doi: 10.3389/fimmu.2020.572754.
• 19. Lai KN, Tang SC, Schena FP, et al. IgA nephropathy. Nat Rev Dis Primers. 2016 Feb 11;2:16001. doi: 10.1038/nrdp.2016.1.
• 20. Park S, Kim HW, Park JT, et al. Relationship between complement deposition and the Oxford classification score and their combined effects on renal outcome in immunoglobulin A nephropathy. Nephrol Dial Transplant. 2020 Dec 4;35(12):2103-2137. doi: 10.1093/ndt/gfz161.
• 21. Deng H, Ma J, Jing Z, et al. Expression of immunoglobulin A in human mesangial cells and its effects on cell apoptosis and adhesion. Mol Med Rep. 2018 Apr;17(4):5272-5282. doi: 10.3892/mmr.2018.8544.
• 22. Stefan G, Stancu S, Boitan B, Zugravu A, Petre N, Mircescu G. Is there a role for IgA/C3 ratio in IgA nephropathy prognosis? An outcome analysis on an European population. Iran J Kidney Dis. 2020 Dec;14(6):470-477.
• 23. Karahisar Şirali S, Büberci R. Correlation between IgAC3 ratio and oxford score in IgA nephropathy. Clin Exp Nephrol. 2022 Oct;26(10):982-987. doi: 10.1007/s10157-022-02244-7.
• 24. Nasri H, Sajjadieh S, Mardani S, et al A. Correlation of immunostaining findings with demographic data and variables of Oxford classification in IgA nephropathy. J Nephropathol. 2013 Jul;2(3):190-195. doi: 10.12860/JNP.2013.30.
• 25. Yamagata K, Ishida K, Sairenchi T, et al. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney Int. 2007 Jan;71(2):159-166. doi: 10.1038/sj.ki.5002017.
• 26. Yu GZ, Guo L, Dong JF, et al. Persistent hematuria and kidney disease progression in IgA nephropathy: a cohort study. Am J Kidney Dis. 2020 Jul;76(1):90-99. doi: 10.1053/j.ajkd.2019.11.008.
• 27. He P, Wang H, Huang C, He L. Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis. Ren Fail. 2021 Dec;43(1):488-499. doi: 10.1080/0886022X.2021.1879852.
• 28. Nam KH, Joo YS, Lee C, et al; Korean GlomeruloNEphritis sTudy (KoGNET) Group. Predictive value of mesangial C3 and C4d deposition in IgA nephropathy. Clin Immunol. 2020 Feb;211:108331. doi: 10.1016/j.clim.2019.108331.