Serum C3 Levels Research Articles

Mitochondrial Complex I Deficiency among Egyptian Pediatric Patients with Steroid-Resistant Nephrotic Syndrome.

Results Positive consanguinity was a remarkable finding in 44 patients among the SRNS group (73%), compared with 33 patients among the SSNS group (55%). Complex I activity was significantly lower in the SRNS group (0.2657 ± 0.1831 nmol/ml/min), than in the SSNS group (0.4773 ± 0.1290 nmol/ml/min) (p < 0.001). There was a significant positive correlation between complex I activity and the heaviness of proteinuria among the SRNS group (r 0.344, p < 0.001). There were statistically significant differences in serum C3 and C4 levels between both groups (p < 0.001, 0.053, respectively). Conclusion Mitochondrial complex I deficiency in patients who have a nephrotic syndrome complaint may play a role in their responsiveness to steroid therapy and the development of SRNS and even the prognosis of their illness.

Disparities between IgG4-related kidney disease and extrarenal IgG4-related disease in a case\u2013control study based on 450 patients

We aimed to compare the demographic, clinical and laboratory characteristics between IgG4-related kidney disease (IgG4-RKD+) and extrarenal IgG4-related disease (IgG4-RKD−) in a large Chinese cohort, as well as describing the radiological and pathological features of IgG4-RKD+. We retrospectively analyzed the medical records of 470 IgG4-related disease (IgG4-RD) patients at Peking University People’s Hospital from January 2004 to January 2020. The demographic, clinical, laboratory, radiological and pathological characteristics between IgG4-RKD+ and IgG4-RKD− were compared. Twenty IgG4-RD patients who had definite etiology of renal impairment including diabetes, hypertension and etc. were excluded. Among the remained 450 IgG4-RD patients, 53 were diagnosed with IgG4-RKD+ . IgG4-RKD+ patients had older age at onset and at diagnosis. Male to female ratio of IgG4-RKD+ patients is significantly higher. In the IgG4-RKD+ group, the most commonly involved organs were salivary gland, lymph nodes and pancreas. It was found that renal function was impaired in approximately 40% of IgG4-RKD+ patients. The most common imaging finding is multiple, often bilateral, hypodense lesions. Male sex, more than three organs involved, and low serum C3 level were risk factors for IgG4-RKD+ in IgG4-RD patients. These findings indicate potential differences in pathogenesis of these two phenotypes.

Effects of andrographolide on lipopolysaccharide‐induced serum biochemical indices, immune responses and intestinal inflammation related to gene expression of Monopterus albus

An 8-week trial investigated how andrographolide effected lipopolysaccharide (LPS)-induced serum biochemical indices, immune responses and the intestinal inflammatory response of Monopterus albus. The study included control and andrographolide groups (150 mg/kg andrographolide) with three replicates per group. Samples were taken 0, 3, 6, 12, 24 and 48 h after LPS injection. The results showed that the levels of GLU, COR, AST, ALT, IgM, LZM, AKP, C3 and C4 in serum showed an initial increasing that then decreased. Compared with that of the control group, the levels of serum LZM, AKP, IgM, C3 and C4 in the andrographolide group increased quicker after LPS injection, while the levels of GLU, COR, AST and ALT increased more slowly; further, these indices recovered to normal levels quicker. The expression of several genes in the intestine first increased and then decreased after LPS injection. Compared with that of the control group, il-10, tgf-β1, tgf-β2 and tgf-β3 gene expression in the andrographolide group increased quicker after LPS injection, while that of il-1β, il-8, il-12β, nf-κb, tlr-3, tlr-7 and tlr-8 increased more slowly; these indices recovered to normal levels more quickly. In conclusion, LPS injection induced immune stress and inflammatory response in M. albus. Dietary supplementation with 150 mg/kg andrographolide effectively alleviated these responses.

Dose-effect relationship between serum polycyclic aromatic hydrocarbon adducts and serum complements among children in a city of East China

Objective: To investigate the dose-response relationship between serum polycyclic aromatic hydrocarbon adducts and serum complement C3 and C4 levels among children from a city in East China. Methods: In September 2016, two boarding schools in the air pollution exposure area and the control area (beyond the upwind of 30 km in the air pollution exposure area) in a city in East China were selected as the research site, and the eligible school-age children were recruited as the research objects. A total of 273 children were included, including 163 in the exposure group and 110 in the control group. The annual air pollutant data (PM2.5, PM10 and NO2) of the two regions during the study period were collected. The exposure level of tobacco was evaluated by cotinine in urine. The levels of serum complement C3 and C4 were determined by automatic biochemical analyzer. The serum anti-7, 8, -dihydrodiol-9, 10-epoxide benzo[a]pyrene (BPDE)-albumin adduct levels were detected by ELISA. Linear regression model was used to explore the dose-response relationship between BPDE-albumin adducts and serum complement C3 and C4. Results: The age of 273 subjects was (13.67±0.37) years old, including 165 boys (60.4%). The average annual exposure levels of PM2.5, PM10 and NO2 and the level of serum BPDE-albumin adducts in the exposure group were higher than those in the control group (P<0.05). The results of linear regression model analysis showed that after adjusting age, sex, BMI z-score and urinary cotinine level, when the serum BPDE-albumin adduct level increased by 10%, the serum complement C4 level decreased by 1.2% (P=0.017). After adjusting age, BMI z-score and urinary cotinine level, for every 10% increase in serum BPDE-albumin adduct level in boys, the serum complement C4 level decreased by 1.68% (P=0.024). After adjusting age, sex and BMI z-score, the levels of serum complement C3 and C4 decreased by 1.31% and 3.57% respectively for every 10% increase in serum BPDE-albumin adducts among children in the urinary cotinine detection group (P<0.05). Conclusion: There is a significant dose-response relationship between serum BPDE-albumin adducts and the complement C4 among children.

Serum complement levels as prognostic marker for monitoring treatment response in lupus nephritis

Background: Lupus nephritis (LN) is one of the most common and serious manifestations of systemic lupus erythematosus (SLE) that causes significant morbidity and mortality. Certain biomarkers for LN are sometimes able to assess treatment response in lupus nephritis. This study aimed to compare serum complement levels (C3 and C4) as markers of treatment response of LN and their relation to the LN class in renal biopsy.&#x0D; Methods: This prospective observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2018 to August 2019. Twenty seven patients who were diagnosed with LN after kidney biopsy were included in this study. Serum complement levels (C3 and C4), 24 hours urinary total protein (24-hr UTP) and anti-double-stranded DNA (anti-ds DNA) were measured in all patients at baseline, 3 months and 6 months after treatment initiation. These biomarker values before and after treatment were compared between the proliferative and non-proliferative LN patients.&#x0D; Results: Serum C3 levels were significantly different between patients with proliferative LN (Class III and Class IV) and non-proliferative LN (Class V) at baseline (0.47 ± 0.32 g/l versus 0.89 ± 0.43 g/l, p=0.009) and levels changed significantly 6 months after treatment initiation (p&lt;0.001) and likewise for serum C4 levels (0.10 ± 0.06 g/l versus 0.24 ± 0.26 g/l, p=0.040). The values of 24-hr UTP and anti-ds-DNA were significantly different 6 months after treatment with p value &lt;0.05 in both groups but C3 (p&lt;0.001) and renal Systemic Lupus Erythematosus Disease Activity Index (rSLEDAI) (p&lt;0.001) were only significant in the proliferative group. On the other hand, after 6 months treatment, C4 levels became relatively higher but that was not significant in both groups (p&gt;0.05).&#x0D; Conclusion: After 6 months of treatment, serum C3 and C4 levels increased towards normal in both LN groups. Serum C3 and C4 levels in patients with LN correlate with disease activity. Therefore, serum complement (C3 and C4) levels may be utilized as serological biomarkers for treatment response of LN.&#x0D; Birdem Med J 2021; 11(2): 97-102

C3 glomerulonephritis associated with ANCA positivity: a case report

BackgroundC3 glomerulopathy (C3G) is a recent disease classification that is characterized by the presence of glomerular deposits (composed of C3) in the absence of significant amounts of immunoglobulin and comprises dense deposit disease and C3 glomerulonephritis (C3GN). Most C3GN manifests as membranoproliferative, mesangial proliferative glomerulonephritis patterns via light microscopy. Pure membranous nephropathy (MN)-like glomerular lesions are rare manifestations of C3GN. Anti-neutrophil cytoplasmic antibodies (ANCAs) are also seldomly reported to be positive in C3GN. Herein, we report the case of a C3GN patient presenting with an MN-like glomerular pattern with ANCA positivity.Case presentationA 68-year-old woman was admitted to a local hospital with elevated serum creatinine for two weeks. Laboratory tests showed a hemoglobin level of 85 g/L. Urinalysis was positive for 2 + protein and 360 RBCs/HPF. Blood biochemistry analysis revealed the following concentrations: albumin, 30.3 g/L; globulin, 46.2 g/L; blood urea nitrogen, 19.9 mmol/L; and serum creatinine, 234 µmol/L. The serum C3 level was 0.4950 g/L, and the serum C4 level was 0.1050 g/L. The direct Coombs test was positive. Serologic testing for ANCA revealed the presence of p-ANCA (1:10) by indirect immunofluorescence microscopy assay, as well as the presence of PR3 1.2 (normal range < 1) and MPO 3.5 (normal range < 1) by enzyme immunoassay. Renal biopsy sample pathology showed 2/6 cellular crescents and thickened glomerular basement membranes. Immunofluorescence testing revealed only diffuse, finely granular depositions of C3 along the glomerular capillary walls in frozen and paraffin-embedded tissue sections. Electron microscopy demonstrated the presence of subepithelial electron-dense deposits, similar to those that are observed in membranous nephropathy. Corticosteroid and cyclophosphamide were administered, with a subsequent improvement in renal function.ConclusionsWe present the rare case of a patient with MN-like C3GN with ANCA positivity. C3GN with ANCA positivity may be represented by more crescents, severe renal dysfunction and more extrarenal manifestations. More cases are needed to elucidate the clinicopathologic features and optimal treatments of these patients.

Association of antiphospholipid antibodies with clinical activity and renal pathological activity in patients with lupus nephritis.

This study aimed to investigate the association of antiphospholipid antibodies (aPL) with clinical activity and renal pathological activity in patients with lupus nephritis (LN). Levels of anticardiolipin () antibodies, anti-β2-glycoprotein I (anti-β2-GPI) antibodies and lupus anticoagulant (LAC) were measured, and other clinical and pathological data were also obtained during the same period before renal biopsy. A total of 83 patients with LN were included in this study, 40 patients (48.2%) in the s positive group and 43 patients in the aPL negative group. LN patients with positive aPL had significantly higher SLEDAI (p = 0.012), more hematuria (p = 0.043), lower serum C3 (p = 0.003) and C4 (p = 0.014), and a higher pathological activity index (p = 0.012), more micro-thrombosis (p = 0.046) and more C3 deposits (p = 0.038) in the glomerulus than patients with negative aPL The level of IgG- was significantly correlated with SLEDAI and serum level of C3 (r = 0.44, p < 0.001; r = -0.39, p = 0.003, respectively). The level of IgM- was significantly correlated with SLEDAI, and serum levels of C3 and C4 (r = 0.27, p = 0.014; r = -0.22, p = 0.041; r = -0.23, p = 0.035, respectively). Our work suggests that aPL, especially, are correlated with both clinical activity and renal pathological activity in patients with LN.

Clinical characteristics and outcome of IgG4-related disease with hypocomplementemia: a prospective cohort study

BackgroundImmunoglobulin G4-related disease (IgG4-RD) is a newly recognized systemic, immune-mediated, and fibro-inflammatory disease. Hypocomplementemia was found in part of IgG4-RD patients especially in the setting of active disease.ObjectivesThis study aimed to clarify the clinical features, treatment efficacy, and outcome in IgG4-RD patients with hypocomplementemia.Methods312 IgG4-RD patients were recruited in our prospective cohort conducted in Peking Union Medical College Hospital. Patients were divided into hypocomplementemia group and normal complement group according to serum C3 and C4 levels measured at baseline before treatment. Low serum C3 levels (< 0.73 g/L) and/or C4 levels (< 0.10 g/L) were defined as hypocomplementemia. Demographic data, clinical characteristics, laboratory parameters, treatment, and outcome of two groups were analyzed and compared.ResultsHypocomplementemia was identified in 65 (20.8%) cases of untreated IgG4-RD patients at baseline. The average age of hypocomplementemia group was 55.85 ± 10.89 years, with male predominance (72.3%). Compared with normal complement group, patients with hypocomplementemia were likely to have more involved organs, higher IgG4-RD responder index (IgG4-RD RI), and higher laboratory parameters such as counts of eosinophils, inflammatory markers, immunoglobulin G (IgG), IgG1, IgG3, IgG4, and IgE. In addition, lymph nodes, lacrimal gland, submandibular gland, parotid gland, paranasal sinus, bile ducts, and prostate gland were more commonly affected (p < 0.05). Serum C3 and C4 showed a significant positively correlation with each other. Both C3 and C4 were negatively correlated with the number of involved organs, IgG, IgG3, IgG4, and IgG4-RD RI, as well as positively correlated with IgA and hypersensitive C reactive protein (hsCRP). 64 (98.5%) patients responded quickly to initial therapy at a 3-month follow-up. Fifteen (23.1%) patients relapsed during follow-up with mean recurrence time of 14.2 ± 13.8 months. Compared with normal complement group, there was no significant difference of relapse rate in two groups (P = 0.401).ConclusionsClinical characteristics of IgG4-related disease with hypocomplementemia differ from normal complement group. Serum C3 and C4 at baseline before treatment could be biological markers for disease activity. IgG4-RD with hypocomplementemia responded well to treatment and had no significant difference of relapse rate in IgG4-RD with normal complement.

ASSESSMENT OF THE SERUM LEVEL OF COMPLEMENT C3 AND C4 IN CHRONIC VIRAL HEPATITIS C INFECTION AND THEIR CORRELATION WITH RESPONSE TO DIRECT ACTING ANTI-VIRAL AGENTS

Background: The interactions between hepatitis C Virus (HCV) and the host immune system have a major role in HCV pathogenesis. Objective: To estimate complement C3 and C4 serum levels in patients with chronic HCV patients and to correlate its levels with response to directly acting anti-viral agents (DAAs) in those patients. Patients and methods: The study included 80 individuals classified into two groups: Group (I): 40 patients with chronic HCV infection, Group (II): Control group which included 40 healthy individuals. Measurement of the level of complement C3 and C4 has done by nephelometry immunoassay before and after treatment with DAAs. Results: All patients with chronic HCV infection in group (I) showed significant reduction in serum levels of complement C3 and C4 compared to the control group (II). Moreover, those patients who treated with DAAs showed significantly higher levels of C3 and C4 when compared to chronic HCV patients before treatment with DAAs. Conclusion: Serum levels of complement C3 and C4 serum may be used in the follow up of the course of the disease and may be used as a predictor for the response to treatment with DAAs.

POS-202 ATYPICAL HEMOLYTIC UREMIC SYNDROME: A RARE CAUSE OF MALIGNANT HYPERTENSION AND ACUTE RENAL FAILURE IN ADULT

Atypical hemolytic uremic syndrome (aHUS) is a form of complement-mediated thrombotic microangiopathy mainly characterized by excessive activation of alternative complement pathway activation. This occurs due to mutation in the complement regulatory proteins or by acquired neutralizing antibodies to these complement regulatory proteins. It is characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury. It usually has a poor prognosis in the absence of prompt recognition and treatment, with more than 50% of the patients progressing to end stage renal disease. Case report- A 21 year old male presented to emergency with sudden onset headache, blurring of vision and multiple episodes of vomiting. There was no history of diarrhea or dysentery in recent past.Thorough examination was done and investigations were performed. On examination, patient had pallor and elevated blood pressure of 200/100 mmHg. Relevant findings on investigations was anemia (hemoglobin: 8.9g/dl), thrombocytopenia (platelet count: 98000cells/cu.mm) and deranged renal function tests (BUN: 156, Creatinine: 7.4mg/dl). LFT showed raised total bilirubin: 2.4mg/dl with direct fraction 0.3mg/dl. LDH and uric acid were also raised(1131U/L and 9.5mg/dl respectively). Urine routine showed trace proteinuria and urine for active sediment was negative for cast. Ultrasound of bilateral kidneys showed normal echogenecity, normal size and a maintained corticomedullary differentiation with a normal renal artery Doppler study. Peripheral smear was suggestive of Normocytic normochromic anemia with occasional target cells, elliptical cells and fragmented RBC’s with a raised reticulocyte count of 6.6. With these reports, a probable diagnosis of hemolytic uremic syndrome was considered. Stool cultures for shiga toxin producing E.coli was negative. The patient had uncontrolled hypertension despite three antihypertensives, thrombocytopenia and renal failure worsened further and patient was initiated on dialysis. Kidney biopsy was done in view of rapidly progressing renal failure which showed prominent subendothelial edema with blood vessels showing mucoid edema with near complete obstruction of lumen of medium sized vessels suggestive of thrombotic microangiopathy with acute tubular necrosis (figure1). Serum C3 levels were significantly on lower side with near normal C4 levels. ADAMTS13 levels were within normal limits. Hence a diagnosis of atypical hemolytic syndrome was finally considered .The test for complement factor H antibody was negative. However further confirmatory investigations like genetic analysis of complement regulatory genes were unavailable. Patient was also started on daily sessions of plasma exchange therapy as eculizumab was not available due to financial constraints. Over next 10 days patients clinical condition started to stabilize with improvement in renal function, anemia and platelet count. Patient was discharged and advised to follow up with monitoring of renal function tests. In patients with hypertensive crisis, acute renal failure and thrombocytopenia, aHUS should be considered. Timely recognition of disease and prompt treatment is essential for favourable outcome. In the face of non-availability of eculizumab, plasmapheresis can be considered as initial treatment option.

RENAL HISTOPATHOLOGICAL PROFILE IN PATIENTS WITH SILENT LUPUS NEPHRITIS

Background: Silent lupus nephritis (SLN) is a life menacing consequence of systemic lupus erythematous (SLE). This condition is characterized by pathological impairment of the kidney in the obscurity of clinical or laboratory manifestations. Objective: To reveal the existence of SLN along with the potential differences between overt lupus nephritis (OLN) and SLN among a sample of Egyptian patients based on histopathological assessment. Patients and Methods: It is a prospective case-control study which was performed at nephrology units, internal medicine department, Elhussein and Sayed Galal university hospitals, faculty of medicine, Al-Azhar University, Cairo, Egypt, throughout the entire period April 2016 to November 2019. Patients aged more than 18 years (216 months) and fulfilled at least 4 of the American College of Rheumatology criteria for the classification of systemic lupus erythematosus (SLE) were enrolled in the current study. Patients were further assorted into two groups; patients with SLN and those with OLN. Patients were subjected to the following investigations: 1.Complete blood count, using Coulter counter Max-M (Coulter Cooperation, Florida, USA) 2.Erythrocyte sedimentation rate, (Wester green method) (Ref: < 20mm/hr) 3.S. Albumin, S. Creatinine. Albumin/Creatinine ratio. Creatinine clearanc & eGFR using the Modification of Diet in Renal Disease (MDRD) formula. 4. Liver function tests. 5. Coagulation profile. 6. Urine analysis (Fresh morning midstream urine) to exclude infection. 7. Quantitative assessment of proteinuria by Pr/creat. Ratio (Ref. <0.2). Assessment of auto-antibodies and complement system: Autoantibodies to ds-DNA, RNP. SSA, SSB, Sm and Scl-70, C4 and C3 serum levels were assessed in all of the included patients. In particular, the titer of anti-dsDNA antibodies was evaluated by enzyme- Radiological evaluation: Patients were subjected to pelvi-abdominal ultrasound in order to obtain valuable data about the morphological appearance of the kidney and to detect any urological abnormality. Renal biopsy: Percutaneous renal biopsy was carried out under local anesthesia. Results: An overall 40 patients with SLE who developed lupus nephritis were enrolled in the current study. Among them, 20 patients had OLN, whereas 20 patients were SLN. Based on ISN/RPS Classification, stage II was the predominant stage, 13 patients, among patients with SLN, whilst stage V was the predominant stage among the OLN patients. Additionally, five and three patients were stage III among the SLN and OLN groups, respectively. Furthermore, the presence of RBCs Cast (r=0.479, P=0.032) in urine and decreased levels of complement (r=0.676, P=0.001) showed a statistically significant positive correlation with the high grades of lupus nephritis among SLN group. Conclusion: Patients with SLE should be subjected to close follow up evaluation and renal biopsy for early detection of SLN to determine the activity, severity, and chronicity of LN.

Effects of age on immune function in broiler chickens

BackgroundThere are many diseases in poultry, many of which are caused by poor immune function. It is not clear how cytokines and various immune cell functions change with age in modern broilers. The purpose of this study was to explore the patterns of development of the immunity of the broiler chickens in cage.ResultsThe results showed that there were 3 development patterns of immunity in the broiler chickens. The first pattern was Down-Up. Cytokines and some immune indicators first decreased and then increased, and the lowest levels of immunity basically occurred from d 6 to 13. The second pattern was Up-Down, and from d 30 to 34, the highest levels of non-specific cellular immunity components, such as the peripheral blood mononuclear macrophage ratio, specific cellular immunity components, such as the peripheral blood helper T (Th) cell ratio and T cell and B cell proliferation activity, and mucosal immunity components, such as the ileal CD4, TGF-β1 and IgA mRNA levels, were observed. The third pattern was Up-Up, and the levels of the non-specific cellular immunity components, such as the serum nitric oxide (NO), C3 and C4 levels, the specific cellular immunity components, such as the spleen index, peripheral blood IL-2, IFN-γ/IL-4, cytotoxic T (Tc) cell ratio, and splenic NF-κB mRNA levels, the humoral immunity components, such as the serum IgG level, the mucosal immunity components, such as the ileal MHC-II, CD3d, TCRβ subunit, TCRζ subunit, IFN-γ, pIgR mRNA and ileal mucosa sIgA levels, were continuing to increase from d 1 to 34.ConclusionsIt could be concluded that the immune system and its function have not developed well in the broiler chickens d 6 to 13 and that the immune system does not mature until d 30 to 34 in the broiler chickens in cages. It is necessary to enhance the immune function of the broiler chickens through nutritional measures from d 1 to 30.

Comparison of inflammatory, nutrient, and neurohormonal indicators in patients with schizophrenia, bipolar disorder and major depressive disorder

Psychiatric disorders are severe, debilitating conditions with unknown etiology and are commonly misdiagnosed, when based solely on clinical interviews, because of overlapping symptoms and similar familial patterns. Until now, no valid and objective biomarkers have been used to diagnose and differentiate between psychiatric disorders. We compared clinically tested serum indicators in terms of inflammation (C-reactive protein, complement proteins C3 and C4, and serum Immunoglobulins A, M, and G), nutrients (homocysteine, folate, and vitamin B12), and neurohormones (adrenocorticotropic hormone and cortisol) in patients with schizophrenia (SCZ, n = 1659), bipolar disorder (BD, n = 1901), and major depressive disorder (MDD, n = 1521) to investigate potential biomarkers. A receiver operating characteristic (ROC) curve was used to analyze the diagnostic potential of these analytes. We found that compared with MDD, serum levels of C-reactive protein, C3, C4, and homocysteine were higher in SCZ and BD groups, and folate and vitamin B12 were lower in SCZ and BD groups. In contrast with BD, adrenocorticotropic hormone and cortisol increased in patients with MDD. Although ROC analysis suggested that they were not able to effectively distinguish between the three, these biological indicators showed different patterns in the three disorders. As such, more specific biomarkers should be explored in the future.

Mesangial C3 deposition and serum C3 levels predict renal outcome in IgA nephropathy.

Complement activation plays an important role in the pathogenesis of IgA nephropathy (IgAN). We aimed to evaluate the relationship between mesangial C3 deposition and histologic lesions and to investigate the role of mesangial C3 deposition and serum C3 reduction in predicting renal outcome in IgAN children. We performed a retrospective cohort study in children with biopsy-proven IgAN. Mesangial C3 deposition (< 2+ vs. ≥ 2+) was detected by the immunofluorescence. Histopathologic kidney grades were determined by the Oxford classification. A decreased serum C3 concentration (hypoC3) was defined when C3 < 90mg/dl. The endpoint was composite kidney outcome with either a 30% decline in glomerular filtration rates from baseline or kidney failure during the follow-up period. A total of 98 children were analyzed. Mesangial hypercellularity (M) was an independent factor associated with mesangial C3 deposition (HR 3.267; 95% CI 1.028-10.389; P = 0.045). After a median follow-up period of 25months (interquartile range 18-36months), 6 (6.1%) children reached the endpoint. Compared with other children, a significantly higher proportion of children with composite kidney outcomes had mesangial C3 deposition ≥ 2+ and hypoC3 (3.4% versus 27.3%, P = 0.002). After adjustment for clinicopathologic risk factors, mesangial C3 deposition ≥ 2+ and hypoC3 were associated with renal outcome (HR 9.772; 95% CI 1.264-75.518; P = 0.029). Mesangial C3 deposition was associated with M in IgAN. Mesangial C3 deposition and hypoC3 were risk factors for renal outcome in children with IgAN.

Changes in the growth, ileal digestibility, intestinal histology, behavior, fatty acid composition of the\xa0breast muscles, and blood biochemical parameters of broiler chickens by dietary inclusion of safflower oil and vitamin C

BackgroundThe effects of safflower oil and vitamin C (Vit. C) inclusion in broiler chicken diets on the growth performance, apparent ileal digestibility coefficient “AID%” of amino acids, intestinal histology, behavior, carcass traits, fatty acid composition of the breast muscle, antioxidant and immune status for a 35-day feeding period were evaluated. A total of 300 three-day-old Ross chicks (58.25 g ± 0.19) were randomly allotted in a 2 × 3 factorial design consisting of two levels of vitamin C (0 and 400 mg/kg diet) and three levels of safflower oil (0, 5, and 10 g/kg diet).ResultsAn increase in the final body weight, total body weight gain, total feed intake, and the relative growth rate (P < 0.05) were reported by safflower oil and vitamin C inclusion. Dietary supplementation of safflower oil and vitamin C had a positive effect (P < 0.05) on the ingestive, resting, and feather preening behavior. Vitamin C supplementation increased (P < 0.05) the AID% of lysine, threonine, tryptophan, arginine, and valine. Safflower inclusion (10 g/kg) increased (P < 0.05) the AID% of methionine and isoleucine. Safflower oil inclusion increased (P < 0.05) the levels of stearic acid, linoleic acid, saturated fatty acids, and omega-3 fatty acids (ω-3) in the breast muscle. In contrast, the supplementation of only 10 g of safflower oil/kg diet increased (P = 0.01) the omega-3/omega-6 (ω-3/ω-6) fatty acids ratio. Vit. C supplementation increased (P < 0.05) the CAT serum levels, SOD, and GSH enzymes. Dietary supplementation of safflower oil and vitamin C improved the intestinal histology. They increased the villous height and width, crypt depth, villous height/crypt depth ratio, mucosal thickness, goblet cell count, and intra-epithelium lymphocytic lick cell infiltrations. The serum levels of IgA and complement C3 were increased (P < 0.01) by Vit. C supplementation and prominent in the 400 vit. C + 10 safflower Oil group.ConclusionA dietary combination of safflower oil and vitamin C resulted in improved growth rate, amino acids AID%, intestinal histology, welfare, immune and antioxidant status of birds, and obtaining ω-3 and linoleic acid-enriched breast muscles. The best inclusion level was 400 vit. C + 10 safflower Oil.

The Correlation between Serum C3 and C4 Complement Levels with Disease Activity Systemic Lupus Eritematosus Patients In Dr. Soetomo Hospital, Surabaya

Introduction: The Systemic lupus erythematosus (SLE) is autoimmune disease that results in inflammation, and tissue damage. SLE often creates difficulties in the diagnosis and assessment of disease activity. Disease activity is important as basis for selecting the appropriate therapy. In addition to clinical SLE, supporting investigations are needed to determine disease activity, one of which is complement examination. Complement plays an important role in autoimmune disease and thought to mediate tissue damage. This study aimed to analyze correlation between serum complement C3 and C4 levels with disease activity of SLE patients in Dr. Soetomo Hospital Surabaya.Methods: This study used an observational analytic method with a cross-sectional design. The sampling technique was consecutive sampling. The samples of this study were SLE patients who were treated in the inpatient room and poly rheumatology in January-December 2018 periods. The data were analyzed statistically using the Pearson test.Results: There were 150 SLE patients, most of whom were women (90.0%) with mean age of 29.01±9.8 years. Most levels of complement were low levels (C3 = 48.0% and C4 = 50.7%). Most disease activities were severe flares (44.7%). Results of the Pearson test complement C3 with disease activity were p =0.001, and level of correlation was r =-0.287. However, results of the Pearson test complement C4 with disease activity were p =0.026, and level of correlation was r =-0.182.Conclusion: There is negative correlation between C3 and C4 complement levels with disease activity of SLE patients in Dr. Soetomo Hospital, Surabaya which is significant, weak and opposite.

Features of serum complement C3 and C4 levels in autoimmune hemolytic anemia patients.

Abnormally activated complement system induces erythrolysis in a part of autoimmune hemolytic anemia (AIHA) patients. However, the alterations in serum complement levels in these patients are seldom reported. In this study, we aimed to evaluate the serum complement features of AIHA patients according to different clinical and laboratory characteristics and to find relationships between complement levels and hemolysis-associated laboratory indexes. A retrospective analysis of 146 AIHA patients was performed, and serum complement C3 and C4 levels were compared between control subjects and AIHA patients with different subtypes. Correlations of serum C3/C4 levels with titers of cold agglutinin test (CAT), direct antiglobulin test (DAT), and serological indexes were assessed. Spearman correlation analysis was performed to analyze the relationship between serum complement levels and other laboratory indexes. Autoimmune hemolytic anemia patients showed reduced serum C3 levels, while serum C4 levels tended to be lower in DAT-positive AIHA patients but not in DAT-negative AIHA patients. Patients with warm AIHA secondary to connective tissue diseases and cold agglutinin disease/cold agglutinin syndrome had the lowest serum C3/C4 levels. Serum C4 levels were negatively correlated with CAT (P=.004) and DAT (anti-C3d) (P=.007) titers. In patients with positive CAT and/or DAT (anti-C3d) but negative DAT (anti-IgG), serum C3/C4 levels were negatively correlated with indirect bilirubin (P=.017 and =.026, respectively). The study findings may be helpful in not only unraveling the mechanism underlying hemolysis in AIHA but also diagnosing AIHA and selecting targeted treatment strategies.

IMPACT OF TREATMENT WITH DIRECT ACTING ANTIVIRAL AGENTS (DAAS) ON MIXED CRYOGLOBULINEMIA OF HCV EGYPTIAN PATIENTS

Background: Up to 74% of patients affected by HCV have HCV-related extrahepatic manifestation (EHMs) including autoimmune diseases, mixed cryoglobulinemia (MC) and non-Hodgkin lymphomas (NHL).Objective: To study the impact of treatment with direct acting antiviral agents (DAAS) on mixed cryoglobulinemia of HCV Egyptian patients. Patients and methods: This study was carried out in cooperation between the Hepato-gastroenterology and Infectious Diseases Department, Al-Azhar University, Cairo, and Shebin Elkom Fever Hospital from March 2018 to December 2019. The study included 80 patients with HCV-related EHMs including cutaneous (30 patients), musculoskeletal (30 patients) and renal manifestation (20 patients). All patients were naive to treatment with DAAs (Sofosbuvir/Daclatasvir ± Ribavirin regimen). Results: Purpuric papules of the lower extremities were the most frequent cutaneous lesion (80%), and arthralgia was the most frequent in musculoskeletal manifestations (90%). Diffuse membranoproliferative glomerulonephritis was the most frequent lesion in patients, with renal manifestations (90%). Significant increase occurred in the serum cryoglobulin levels and RF, with significant decreasein C3 and C4 serum levels in all groups. There were significant decrease in the mean cryoglobulin levels from positive to negative, with significant decline in RF concentrations, and rise in C3 and C4 serum levels approaching the normal values. There were improvements in the presenting HCV-MC clinical manifestations in variable degrees, rangingfrom 71.42% in patients with glomerulonephritis to 98.4% in patients with purpura. Eighty-seven percent of the included patients showed complete response (clinical, virologicaland immunological recovery), and 13% showed partial response (virological and immunological recovery without clinical improvement of cryoglobulinemia associated manifestations). Conclusion: DAAs, in the form of Sofosbuvir/Daclatasvir ± Ribavirin regimen, were treatment of choice for HCV infection, and considered in cases of HCV-MC as they were associated with clinical improvement in most patients.

Carbamazepine-Induced Hematological and Immunological Alterations in Egyptian Children with Idiopathic Generalized Seizures

AbstractCarbamazepine (CBZ) is one of the oldest antiepileptic drugs (AEDs) that is still used for the treatment of tonic-clonic seizures in children. Long-term use of AEDs induces potential toxic effects that may remain undetermined for a long time. Earlier studies have revealed a wide spectrum of hematological toxicities associated with CBZ. This study was conducted to unveil the toxic effects of carbamazepine as an antiepileptic monotherapy on hematological and immunological parameters in a group of Egyptian pediatric patients using it for different durations. Fifty pediatric epileptics of either sex were enrolled; 38 were taking CBZ as antiepileptic monotherapy for ≥ 6 months and 12 were newly diagnosed untreated patients. Hematological and immunological parameters studied were compared with their age and sex-matched 15 controls and among groups. CBZ was found more toxic for total leukocyte count, lymphocyte count, serum IgA and IgM levels (p &lt; 0.001, 0.001, &lt; 0.001, &lt; 0.001, respectively). Hemoglobin level, platelets count, serum C4 level and IgA were negatively correlated with serum CBZ level (Spearman's rho = – 0.62, – 0.42, – 0.34, – 0.13; p &lt; 0.001, 0.008, 0.04, 0.44, respectively). CBZ treatment duration associated inversely with platelets, lymphocyte, and eosinophil counts (p &lt; 0.001, 0.03, 0.01, respectively). Epileptic children on CBZ monotherapy had their hematologic and immunologic systems affected, which mandates routine monitoring of these children.

Association of Serum Complement Components (C3 and C4) with Disease Activity in Yemeni Bronchial Asthmatic Patients

Objective: To assess the role of the complement components (C3 and C4) in the pathogenesis and severity of bronchial asthma (BA) among Yemeni patients.&#x0D; Methods: This cross-sectional, clinic-based study was conducted in Sana’a city, Yemen in the period from March to June 2012. It included 100 BA patients, where demographic and clinical data were collected using a pre-designed, structured questionnaire. Blood samples then collected by venipuncture, and sera were then separated and tested for the levels of C3 and C4 by immunoturbidimetry assay. Data were analyzed using suitable statistical tests using IBM SPSS Statistics, version&#x0D; Results: Of 100 patients, 53% were males and 29% were older than 40 years. The mean age of patients was 34.7± 17.5 years (range: 6–80). The majority of patients had active asthma (81.0%) and experienced asthma for more than two years (66.0%). Dyspnea (81.0%) and cough (65.0%) were the most frequent clinical features, while edema (11.0%) was the least frequent clinical feature among asthmatic patients. The mean level of serum C3 among BA patients was elevated (127.9 ± 21.3 mg/dL) and was significantly higher among females, patients aged 40 years or older and those with active BA, but there was no statistically significant difference with respect to the duration of asthma. In contrast, the mean level of serum C4 was normal (27.6 ± 8.8 mg/dL) but was significantly higher among patients aged 40 years or older and those having asthma for more than two years. Wheezing was significantly associated with the mean level of serum C3 among BA patients. Similarly, the mean level of serum C4 was significantly higher among patients having cough.&#x0D; Conclusions: The majority of Yemeni patients with BA have elevated levels of serum C3, which can be significantly higher in females, patients older than 40 years and those with active asthma. On the other hand, the levels of serum C4 are normal among the majority of Yemeni patients with BA, but these can be elevated among those with severe clinical features or long-term asthma.&#x0D; Keywords: Active asthma, Bronchial asthma, Complement, C3, C4, Yemen