Abstract
BackgroundThe aim of the study was to investigate the clinical relevance of IgM deposition in patients with lupus nephritis (LN) in a large cohort.Results217 patients with renal biopsy-proven active LN were enrolled. The associations between glomerular IgM deposition and clinicopathological parameters were further analyzed. IgM deposition was positively correlated with glomerular C1q and C3 deposition moderately (r = 0.436, P < 0.001; r = 0.408, P < 0.001, respectively), and inversely correlated with plasma levels of C3 and CFH mildly (r = − 0.138, P = 0.043; r = − 0.147, P = 0.037, respectively). By multivariate analysis, we found that glomerular IgM deposition independently contributed to glomerular C3 deposition in patients with LN (OR = 2.002, 95% CI 1.295–3.094, P = 0.002). In addition, we also found that patients with IgM 0–2+ had similar plasma CFH levels, but in patients with IgM3+–4+, plasma CFH levels were significantly lower (300.4 ± 155.8 μg/mL vs. 429.9 ± 187.5 μg/mL, P < 0.001). Furthermore, patients with high density of glomerular IgM and low levels of CFH had heavier proteinuria, higher serum creatinine and lower plasma C3 levels (5.7 ± 3.1 g/d vs. 4.7 ± 3.5 g/d, P = 0.037; 150.1 ± 121.0 μmol/L vs. 105.6 ± 97.1 μmol/L, P = 0.005; 0.3 ± 0.2 μg/L vs. 0.4 ± 0.2 μg/L, P = 0.04, respectively), comparing with those with low density of glomerular IgM and low levels of CFH.ConclusionsOur results suggested the involvement of glomerular deposited IgM in complement activation and renal injury in LN.
Highlights
The aim of the study was to investigate the clinical relevance of IgM deposition in patients with lupus nephritis (LN) in a large cohort
We found that plasma complement factor H (CFH) levels in patients with LN at active phase were significantly lower than those in non-renal systemic lupus erythematosus (SLE) patients or those in normal controls, and plasma CFH levels were negatively associated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores and positively associated with serum C3 levels
We firstly investigated the clinical relevance of renal IgM deposition and the relationship of plasma CFH levels with glomerular IgM deposition in a large Chinese LN cohort
Summary
The aim of the study was to investigate the clinical relevance of IgM deposition in patients with lupus nephritis (LN) in a large cohort. In mice deficient in the complement factor H (CFH), a model of non-sclerotic and nonimmune-complex glomerular disease, IgM was identified as binding to glomerular epitopes and contributing to the progression of glomerular damage [5]. In another animal model of adriamycininduced focal segmental glomerulosclerosis (FSGS), IgM deposition activated the complement system and mediated glomerular injury [6]. In the subsequent clinical studies, IgM deposition independently associated with worse renal outcomes in patients with various glomerular
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