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Histological reappraisal of IgA nephropathy: the role of glomerular pattern of injury and mesangial complement deposition.
Obrișca, Bogdan; Mocanu, Valentin; Jurubița, Roxana; Vrabie, Alexandra; Berechet, Andreea; Lujinschi, Ștefan; Sorohan, Bogdan; Andronesi, Andreea; Achim, Camelia; Lupușoru, Gabriela; Micu, Georgia; Caceaune, Nicu; Gherghiceanu, Mihaela; Ismail, Gener.
Affiliation
  • Obrișca B; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. obriscabogdan@yahoo.com.
  • Mocanu V; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania. obriscabogdan@yahoo.com.
  • Jurubița R; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
  • Vrabie A; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
  • Berechet A; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
  • Lujinschi Ș; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
  • Sorohan B; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
  • Andronesi A; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
  • Achim C; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
  • Lupușoru G; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
  • Micu G; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
  • Caceaune N; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
  • Gherghiceanu M; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
  • Ismail G; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
BMC Nephrol ; 25(1): 145, 2024 Apr 24.
Article in En | MEDLINE | ID: mdl-38658875
ABSTRACT

BACKGROUND:

There is a clear need to refine the histological assessment in IgA Nephropathy (IgAN). We sought to investigate the clinical significance of the light microscopy (LM) pattern of glomerular injury and of the intensity of mesangial C3 staining in IgAN.

METHODS:

We conducted a retrospective, observational study that included all patients with biopsy-proven primary IgAN that had at least 12 months of follow-up. The LM pattern of glomerular injury was reevaluated based on a modified HAAS classification. Mesangial C3 deposition by immunofluorescence (IF) staining was scored semi-quantitatively. The study primary composite endpoint was defined as doubling of serum creatinine or ESRD (dialysis, renal transplant or eGFR < 15 ml/min). The secondary study endpoint was eGFR decline per year.

RESULTS:

This cohort included 214 patients with IgAN (mean age, 41.4 ± 12.6 years), with a mean eGFR and median 24-h proteinuria of 55.2 ± 31.5 ml/min/1.73m2 and 1.5 g/day (IQR0.8-3.25), respectively. The most frequent LM pattern was the mesangioproliferative (37.4%), followed by the sclerotic (22.5%) and proliferative/necrotizing patterns (21.4%). Regarding the IF findings, mild-moderate and intense mesangial C3 staining was present in 30.6% and 61.1% of patients, respectively. Those with sclerosing and crescentic patterns had the worst renal survival (5-year renal survival of 48.8% and 42.9%) and the highest rate of eGFR change/year (-2.32 ml/min/y and - 2.16 ml/min/y, respectively) compared to those with other glomerular patterns of injury. In addition, those with intense C3 staining reached the composite endpoint more frequently compared to those without intense C3 staining (35.5% vs. 21.4%, p = 0.04). After multivariate adjustment, patients with crescentic and sclerosing patterns had a 3.6-fold and 2.1-fold higher risk for the composite endpoint compared to those with mesangioproliferative pattern, while an intense mesangial C3 deposition being also associated with a worse renal outcome (HR, 3.33; 95%CI, 1.21-9.2).

CONCLUSIONS:

We have shown that the LM pattern of glomerular injury and the intensity of mesangial C3 deposition might stratify more accurately the renal outcome in patients with IgAN.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Complement C3 / Glomerular Mesangium / Glomerulonephritis, IGA / Kidney Glomerulus Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: BMC Nephrol Journal subject: NEFROLOGIA Year: 2024 Document type: Article Affiliation country:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Complement C3 / Glomerular Mesangium / Glomerulonephritis, IGA / Kidney Glomerulus Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: BMC Nephrol Journal subject: NEFROLOGIA Year: 2024 Document type: Article Affiliation country: