BACKGROUND: Glomerular IgG deposition in patients with IgA nephropathy (IgAN) has been shown to be associated with poor renal survival; however, most published studies to date are too small-scale and inconsistent to provide guidance for clinical practice. METHODS: Based on renal biopsy findings, 742 patients were divided into the following groups: (i) IgA deposition alone (IgA) vs IgA + IgG deposition (IgA + IgG) and (ii) IgG co-deposition confined to the mesangium vs mesangium + capillary loops (CLs). The clinicopathological variables at biopsy and renal outcome were assessed. RESULTS: Of the 742 patients, 182 had IgG co-deposition and 51 had IgG deposits in the mesangium + CLs. Patients with IgG co-deposition were associated with severe clinical and pathological lesions, especially those with a location of IgG deposits in the mesangium +CLs. Kaplan-Meier analysis revealed that a lower renal cumulative survival rate was present in both patients with IgG co-deposition and those with a location of IgG deposits in the mesangium + CLs (all p < 0.05). Moreover, patients with a higher intensity of glomerular IgG deposits or C3 deposits or C1q deposits were also associated with a lower survival rate. A multivariate Cox regression model identified the location of IgG deposits in the mesangium + CLs as an independent risk factor for poor prognosis (HR, 2.11; 95% CI: 1.06-4.18; p = 0.005). CONCLUSIONS: Glomerular IgG co-deposition and the location of glomerular IgG deposits in the mesangium + CLs were both associated with adverse renal outcomes, but only the location of glomerular IgG deposits in the CLs was an independent risk factor for poor prognosis in IgAN.
BACKGROUND: Glomerular IgG deposition in patients with IgA nephropathy (IgAN) has been shown to be associated with poor renal survival; however, most published studies to date are too small-scale and inconsistent to provide guidance for clinical practice. METHODS: Based on renal biopsy findings, 742 patients were divided into the following groups: (i) IgA deposition alone (IgA) vs IgA + IgG deposition (IgA + IgG) and (ii) IgG co-deposition confined to the mesangium vs mesangium + capillary loops (CLs). The clinicopathological variables at biopsy and renal outcome were assessed. RESULTS: Of the 742 patients, 182 had IgG co-deposition and 51 had IgG deposits in the mesangium + CLs. Patients with IgG co-deposition were associated with severe clinical and pathological lesions, especially those with a location of IgG deposits in the mesangium +CLs. Kaplan-Meier analysis revealed that a lower renal cumulative survival rate was present in both patients with IgG co-deposition and those with a location of IgG deposits in the mesangium + CLs (all p < 0.05). Moreover, patients with a higher intensity of glomerular IgG deposits or C3 deposits or C1q deposits were also associated with a lower survival rate. A multivariate Cox regression model identified the location of IgG deposits in the mesangium + CLs as an independent risk factor for poor prognosis (HR, 2.11; 95% CI: 1.06-4.18; p = 0.005). CONCLUSIONS: Glomerular IgG co-deposition and the location of glomerular IgG deposits in the mesangium + CLs were both associated with adverse renal outcomes, but only the location of glomerular IgG deposits in the CLs was an independent risk factor for poor prognosis in IgAN.
Entities:
Keywords:
IgA nephropathy; IgG co-deposition; IgG deposit location; renal pathology
Authors: Hernán Trimarchi; Jonathan Barratt; Daniel C Cattran; H Terence Cook; Rosanna Coppo; Mark Haas; Zhi-Hong Liu; Ian S D Roberts; Yukio Yuzawa; Hong Zhang; John Feehally Journal: Kidney Int Date: 2017-03-22 Impact factor: 10.612
Authors: K Solez; R A Axelsen; H Benediktsson; J F Burdick; A H Cohen; R B Colvin; B P Croker; D Droz; M S Dunnill; P F Halloran Journal: Kidney Int Date: 1993-08 Impact factor: 10.612