Clinical Immunology, 2020.211, 0-0, DOI: https://doi.org/doi: 10.1016/j.clim.2019.108331

Predictive value of mesangial C3 and C4d deposition in IgA nephropathy

Ki Heon Nam, Young Su Joo;Changhyun Lee;Sangmi Lee;Joohwan Kim;Hae-Ryong Yun;Jung Tak Park;Tae Ik Chang;Dong-Ryeol Ryu;Tae-Hyun Yooa;Ho Jun Chin;Shin-Wook Kang;Hyeon Joo Jeong;Beom Jin Lim;Seung Hyeok Han;on behalf of The Korean GlomeruloNEphritis sTudy (KoGNET) Group

Abstract

We aimed to determine the relative contribution of each complement (C3 and C4d) deposition to the progression of IgA nephropathy (IgAN). We enrolled a total of 380 patients with biopsy-confirmed IgAN. Mesangial deposition of C3(< 2+ vs. ≥2+) and C4d(positive vs. negative) was evaluated by immunofluorescence staining and immunohistochemistry, respectively. Study endpoint was the composite of a 30% decline in eGFR or ESRD. The risk of reaching the primary outcome was significantly higher in patients having C3≥2+ and C4d(+) than in corresponding counterparts. Adding C3 deposition to clinical data acquired at kidney biopsy modestly increased the area under the receiver-operating characteristic curve, net reclassification improvement, and integrated discrimination improvement (IDI); adding C4d increased IDI only. In conclusion, mesangial C3 and C4d deposition was an independent risk factor for progression of IgAN. C3 showed better predictability than C4d, suggesting that lectin pathway alone has limited clinical prognostic value.

• DOI: https://doi.org/doi: 10.1016/j.clim.2019.108331
• ISBN or ISSN: 1521-6616

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.