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Mesangial C4d deposition at diagnosis in childhood immunoglobulin A nephropathy
Author(s) -
Sato Yasuyuki,
Sasaki Satoshi,
Okamoto Takayuki,
Takahashi Toshiyuki,
Hayashi Asako,
Ogawa Yayoi,
Ariga Tadashi
Publication year - 2019
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13921
Subject(s) - medicine , nephropathy , antibody , immunology , endocrinology , diabetes mellitus
Abstract Background Immunoglobulin A nephropathy (Ig AN ) is a major cause of end‐stage renal disease. Complement activation via the lectin pathway influences outcomes in Ig AN . We examined the association of glomerular C4d deposition with clinicopathological severity at diagnosis and the disappearance of proteinuria in Japanese pediatric Ig AN patients. Methods We retrospectively analyzed 25 children newly diagnosed with Ig AN at Hokkaido University Hospital. We evaluated glomerular C4d immunofluorescent staining at diagnosis. We compared clinical findings, pathological findings (based on Oxford classification), and the disappearance of proteinuria within 24 months after renal biopsy between C4d‐positive and C4d‐negative patients. Results Glomerular C4d staining was observed in 14 patients (56.0%). C4d‐positive patients had significantly higher proteinuria at diagnosis than C4d‐negative patients (2.03 g/ gC r vs 0.78 g/ gC r; P = 0.005). The number of glomeruli with segmental glomerulosclerosis or adhesion (8.0% vs 0.0%; P = 0.046) and the extent of tubular atrophy/interstitial fibrosis (9.46% vs 2.86%; P = 0.031) were significantly increased in C4d‐positive patients compared with C4d‐negative patients. Further, the proportion of patients with modified T1 (>10%) was significantly higher in the C4d‐positive group than the C4d‐negative group. There was no significant difference, however, in the disappearance rate of proteinuria at 24 months after renal biopsy between groups (64% vs 82%; P = 0.149). Conclusions Glomerular C4d deposition was associated with clinicopathological severity at diagnosis in Japanese pediatric patients with Ig AN . Glomerular C4d deposition, however, was not a predictor of the disappearance of proteinuria within 24 months after diagnosis in Japanese pediatric patients with Ig AN .