Abstract
BackgroundGalactose-deficient IgA1 (Gd-IgA1) has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgAN pathogenesis by accumulating in the glomerular mesangium. Several studies showed that glomerular IgG deposition in IgAN is an important cause of mesangial proliferation and glomerular damage. This study aims to determine the association of the positivity of IgG and the intensity of IgG staining with a poor renal prognosis.MethodsA total of 943 IgAN patients were included in the study. Glomerular IgG staining negative and positive patients were compared using Oxford classification scores, histopathological evaluations, proteinuria, eGFR, albumin, blood pressures. IgG positive patients were classified as (+), (++), (+++) based on their staining intensity, and the association with the prognostic criteria was also evaluated.Results81% (n = 764) of the patients were detected as IgG negative, while 19% (n = 179) were positive. Age, gender, body mass index, blood pressure, proteinuria, eGFR, uric acid values were similar in IgG positive and negative patients who underwent biopsy (p > 0.05). Intensity of glomerular IgG positivity was not found to be associated with diastolic and systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p > 0.05 for all, r = − 0.084, r = − 0.102, r = − 0.006, r = 0.062, r = 0.014, r = − 0.044, r = − 0.061, r = − 0.066, r = 0.150, respectively). There was no difference for histopathological findings between IgG (+), IgG (++), IgG (+++) groups (for all, p > 0.05).ConclusionGlomerular IgG negativity and positivity detected by routine IFM in IgAN patients is not associated with poor renal prognostic risk factors.
Highlights
Galactose-deficient IgA1 (Gd-IgA1) has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgA nephropathy (IgAN) pathogenesis by accumulating in the glomerular mesangium
To the best of our knowledge, our study is the first study that the intensity of glomerular IgG staining in IgAN patients was not related to poor prognostic factors and emphasises the importance of IgG positivity, as well as IgG negativity in IgAN patients
It has been reported that IgG accumulation in both mesangium and capillary loops is not different for poor renal prognostic factor [14], some studies have reported that IgG accumulation in capillary loops is highly related to poor renal prognosis than mesangial IgG accumulation [5]
Summary
Galactose-deficient IgA1 (Gd-IgA1) has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgAN pathogenesis by accumulating in the glomerular mesangium. Several studies showed that glomerular IgG deposition in IgAN is an important cause of mesangial proliferation and glomerular damage. Gd-IgA1 has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgAN pathogenesis by accumulating in the glomerular mesangium. Several studies showed that glomerular IgG deposition in IgAN is an important cause of mesangial inflammation, which causes proliferation of the mesangial cells and glomerular damage. Some studies stated that IgG accumulation rather than IgA accumulation in mesangium was associated with poor renal outcome [1, 4, 5]. Albeit not intensely stained or not detected with IFM, glomerular IgG may be associated with poor renal outcomes, such as severe staining cases
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