Abstract
IntroductionIgAN occurs following abnormal IgA deposition in the glomerular mesangial regions. It is the most common primary glomerular disease and one of the causes of ESRD, so it is necessary to identify clinical and histopathological findings that predict progression to ESRD. In the physiopathology of this disease, C4d causes serious renal injuries and should be counted as a significant prognostic factor too. This study examined C4d biomarker and compare it with findings affecting prognosis, to determine the predictive value of C4d in progression to ESRD in IgAN.Materials and methodsIn this study, all biopsy samples of IgAN patients who referred to Imam Reza Hospital in Tabriz were collected for four years. Their samples were evaluated C4d immunohistochemical staining and positive samples have compared with Clinical-histopathological findings affecting prognosis.ResultsIn this study, C4d positivity showed a significant association with mesangial hypercellularity (p = 0.001), segmental glomerulosclerosis (p = 0.003), and endocapillary hypercellularity (p = 0.001); however, it did not show a significant relationship with tubular atrophy/interstitial fibrosis (p = 0.08). The study also found that C4d positivity was significantly (p < 0.05) correlated with hypertension, increased proteinuria, hematuria, high creatinine, and decreased mean eGFR.ConclusionThis study showed that immunohistochemical staining of C4d is a useful method for evaluating the prognosis of the severity of renal injuries in patients with IgAN and could be a valuable alternative for most Clinical-histopathological factors routinely used as predictive factors for its progression to ESRD, especially when the biopsy specimen size is small and insufficient for other studies.
Highlights
I gA nephropathy (IgAN) occurs following abnormal IgA deposition in the glomerular mesangial regions
This study showed that immunohistochemical staining of C4d is a useful method for evaluating the prognosis of the severity of renal injuries in patients with IgAN and could be a valuable alternative for most Clinicalhistopathological factors routinely used as predictive factors for its progression to end-stage renal disease (ESRD), especially when the biopsy specimen size is small and insufficient for other studies
The statistical analysis showed that there was a significant association between decreased eGFR and increased immunoreactivity for C4d marker in patients with IgAN (P-value 1⁄4 0.032), as the mean eGFR was 52.00 ml/min for patients who were positive for C4d, while it was 68.053 ml/min for patients who were negative for this marker (Table 2)
Summary
IgAN occurs following abnormal IgA deposition in the glomerular mesangial regions It is the most common primary glomerular disease and one of the causes of ESRD, so it is necessary to identify clinical and histopathological findings that predict progression to ESRD. It has been observed that in patients with activated lectin pathway, the risk of severe renal failure is increased and is significantly reduced within ten years [3] Based on this evidence, it seems that C4d can be considered a significant prognostic factor as an indicator of lectin pathway activation. It seems that C4d can be considered a significant prognostic factor as an indicator of lectin pathway activation This disease is one of the most leading causes of end-stage renal disease (ESRD), so it is crucial to identify Clinical-histopathological factors that predict progression to ESRD.
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