IgA肾病肾小球内C4d沉积与临床病理的联系

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Abstract Objective: To explore glomerular C4d deposition whether it is a new prognostic factor in IgA nephropathy. Methods: Seventy-eigth patients with the primary IgAN who underwent renal biopsy at our centre were enrolled from January 2011 to May 2014. Patients with diabetes, hypertension, systemic disease, and any type of secondary IgAN were excluded. C4d was detected with immunohistochemical staining in the paraffin embedded renal tissues, using a polyclonal antibody. The cases were divided into positive group and negative group according to the staining of C4d. Then the clinical and pathological parameters were compared between these two groups respectively. Results: Of 78 cases with the primary IgAN, 26 cases (33.3%) were defined as positive group and 52 cases (66.7%) were defined as negative group. C1q detections were negative by immunofluorescence in all these cases. Compared with negative group, C4d-positive patients had gross hematuria in less proportion, had higher incidence of hyperuricemia (male>488 μmol/L; female>363 μmol/L), low estimated glomerular filtration rate [eGFR<60 mL • min-1• (1.73 m2)-1] and hypoalbuminemia (Alb<30 g/L) at the time of renal biopsy. C4d-positive patients also had higher levels of serum creatinine and 24-hour urine protein. The proportion of patients with mesangial proliferation (M1), segmental sclerosis (S1), tubular atrophy or interstitial fibrosis (T1) was higher in C4d-positive group according to the Oxford pathologic classification criteria. Between positive group and negative group, there were no significant differences in gender, age, the course of disease, the incidence of high levels of serum IgA (>400 mg/dl), low levels serum complement C3 (<70 mg/dl) and the glomerular endothelial cell hyperplasia (E1) (P>0.05). Logistic regression univariate analysis showed that the glomerular deposition of complement C4d was correlated with gross hematuria, 24-hour urine protein, low eGFR, hypoalbuminemia, hyperuricemia, M1, S1, T1 (P<0.05). Conclusion: The patients with positive glomerular C4d staining with IgAN has heavier clinical injuries and pathological lesions, which suggests that glomerular activation of the lectin pathway of complement in IgA nephropathy is associated with more severe renal disease.

Key words： IgA nephropathy complement C4d the mannose binding lectin pathway

Received: 17 October 2014

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	ZHANG Ting
	CHEN Bo
	LI Fanfan
	CHEN Xiaoqian
	HUANG Zhaoxing.

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2015/V45/I7/538

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