Feng Ping Ji1,2, Lu Wen3, Yan Ping Zhang1,2, Er Peng Liu1,2, Jian Guo Wen4,5. 1. Pediatric Urodynamic Centre, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. 2. Department of Urology, First Affiliated Hospital of Zhengzhou University, Jianshe East Road No.1, Zhengzhou, 450052, China. 3. Department of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. 4. Pediatric Urodynamic Centre, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. wenjg@hotmail.com. 5. Department of Urology, First Affiliated Hospital of Zhengzhou University, Jianshe East Road No.1, Zhengzhou, 450052, China. wenjg@hotmail.com.
Abstract
PURPOSE: Few studies have reported the roles of the complement system in concomitant idiopathic membranous nephropathy and IgA nephropathy (IMN-IgAN). Complement factor B (CFB) is a crucial factor that involved in the alternative complement pathway. We aimed to evaluate the association between disease activity (eGFR, anti-PLA2R antibody levels and 24 h urinary protein excretion), progression and serum CFB levels of IMN-IgAN patients. METHODS: In total, 39 IMN-IgAN patients (median follow-up, 46.6 months), 99 IMN patients and 92 IgAN patients participated in this study. The disease progression event was defined as end-stage renal disease (ESRD) or a 30% decline in estimated glomerular filtration rate (eGFR). The serum CFB concentration was measured by enzyme-linked immunosorbent assay. RESULTS: Serum CFB levels were lower in IMN-IgAN patients than in patients with IgAN only (P < .001). Serum CFB levels correlated positively with serum creatinine levels, anti-PLA2R antibody levels and 24 h urinary protein excretion (P < .05). Kaplan-Meier analysis revealed that IMN-IgAN patients with high serum CFB levels had a significantly lower cumulative renal survival rate than patients with low levels (log-rank test, P = .009). Multivariate Cox regression analysis showed that high baseline serum CFB levels were significantly associated with poor renal outcome in patients with IMN-IgAN (HR: 2.727, 95% CI 1.076-6.913, P = .034). CONCLUSION: High serum CFB levels correlated with increased serum creatinine, anti-PLA2R antibody and urinary protein excretion as well as poor renal prognosis in patients with IMN-IgAN, indicating that serum CFB may be a marker of disease activity and progression.
PURPOSE: Few studies have reported the roles of the complement system in concomitant idiopathic membranous nephropathy and IgA nephropathy (IMN-IgAN). Complement factor B (CFB) is a crucial factor that involved in the alternative complement pathway. We aimed to evaluate the association between disease activity (eGFR, anti-PLA2R antibody levels and 24 h urinary protein excretion), progression and serum CFB levels of IMN-IgAN patients. METHODS: In total, 39 IMN-IgAN patients (median follow-up, 46.6 months), 99 IMN patients and 92 IgAN patients participated in this study. The disease progression event was defined as end-stage renal disease (ESRD) or a 30% decline in estimated glomerular filtration rate (eGFR). The serum CFB concentration was measured by enzyme-linked immunosorbent assay. RESULTS: Serum CFB levels were lower in IMN-IgAN patients than in patients with IgAN only (P < .001). Serum CFB levels correlated positively with serum creatinine levels, anti-PLA2R antibody levels and 24 h urinary protein excretion (P < .05). Kaplan-Meier analysis revealed that IMN-IgAN patients with high serum CFB levels had a significantly lower cumulative renal survival rate than patients with low levels (log-rank test, P = .009). Multivariate Cox regression analysis showed that high baseline serum CFB levels were significantly associated with poor renal outcome in patients with IMN-IgAN (HR: 2.727, 95% CI 1.076-6.913, P = .034). CONCLUSION: High serum CFB levels correlated with increased serum creatinine, anti-PLA2R antibody and urinary protein excretion as well as poor renal prognosis in patients with IMN-IgAN, indicating that serum CFB may be a marker of disease activity and progression.
Keywords:
Concomitant idiopathic membranous nephropathy and IgA nephropathy; Idiopathic membranous nephropathy; IgA nephropathy; Prognosis; Serum complement factor B
Authors: Nicholas R Medjeral-Thomas; Hannah J Lomax-Browne; Hannah Beckwith; Michelle Willicombe; Adam G McLean; Paul Brookes; Charles D Pusey; Mario Falchi; H Terence Cook; Matthew C Pickering Journal: Kidney Int Date: 2017-06-30 Impact factor: 10.612