Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.

Mesangial C4d deposits have been associated with worse outcomes in Western patients with IgA nephropathy (IgAN), but there is limited data in Asians. Previously, a high proportion of stained glomeruli was often required for the classification of C4d positive (C4d+ve). Positive staining in lower prop...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Suchin Worawichawong, Sirithep Plumworasawat, Wisit Liwlompaisan, Vasant Sumethkul, Bunyong Phakdeekitcharoen, Umaporn Udomsubpayakul, Panus Chalermsanyakorn, Chagriya Kitiyakara
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6d3102b080a7423e8ca1d0452ef9ef0a
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:6d3102b080a7423e8ca1d0452ef9ef0a
record_format	dspace
spelling	oai:doaj.org-article:6d3102b080a7423e8ca1d0452ef9ef0a2021-12-02T20:11:07ZDistribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.1932-620310.1371/journal.pone.0252638https://doaj.org/article/6d3102b080a7423e8ca1d0452ef9ef0a2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252638https://doaj.org/toc/1932-6203Mesangial C4d deposits have been associated with worse outcomes in Western patients with IgA nephropathy (IgAN), but there is limited data in Asians. Previously, a high proportion of stained glomeruli was often required for the classification of C4d positive (C4d+ve). Positive staining in lower proportion of staining would be classified as C4d-ve. This retrospective study evaluated the prognostic value of C4d+ve using a less stringent definition (one C4d+ve glomerulus) in Thai patients with IgAN (n = 120). Baseline findings and outcomes were compared between those with more extensive C4d staining patterns and those with more restricted staining. Clinico-pathologic parameters and risk for kidney outcomes (kidney failure or decline GFR50%) were compared between C4d+ve versus C4d-ve, and between different patterns: Focal (< 50%) versus Diffuse (≥ 50% of glomeruli); or Global (≥ 50) versus Segmental (< 50% of mesangial area). The hazard ratios were estimated using Cox proportional hazard models for Model 1 (Oxford score+ C4d) and Model 2 (Model 1+ clinical factors). C4d+ve (n = 81) had lower eGFR, more global sclerosis, and interstitial fibrosis than C4d-ve at baseline. The 5-year kidney survival for C4d+ve was lower (53.7%) than C4d-ve (89.7%); P = 0.0255. By univariate analysis, T1, T2, C4d+ve, eGFR<60, proteinuria were predictors of kidney outcome. By multivariate analysis, proteinuria, T1, T2 and C4d+ve were independent predictors (Model 2 HR (95% CI) C4d+ve: 3.24 (1.09-9.58), p = 0.034). Segmental had lower eGFR, higher tubulointerstitial fibrosis, and segmental sclerosis compared to Global pattern. Clinicopathological parameters were not different between Focal and Diffuse patterns. Outcomes were similar between staining patterns. In conclusion, C4d staining may be a valuable marker of poor prognosis in Asian patients with IgAN. Less stringent criteria for C4d+ve should be considered as no differences in outcomes were observed between more extensive staining with less extensive patterns. More studies are needed to identify the optimum criteria for C4d+ve.Suchin WorawichawongSirithep PlumworasawatWisit LiwlompaisanVasant SumethkulBunyong PhakdeekitcharoenUmaporn UdomsubpayakulPanus ChalermsanyakornChagriya KitiyakaraPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252638 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Suchin Worawichawong Sirithep Plumworasawat Wisit Liwlompaisan Vasant Sumethkul Bunyong Phakdeekitcharoen Umaporn Udomsubpayakul Panus Chalermsanyakorn Chagriya Kitiyakara Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.
description	Mesangial C4d deposits have been associated with worse outcomes in Western patients with IgA nephropathy (IgAN), but there is limited data in Asians. Previously, a high proportion of stained glomeruli was often required for the classification of C4d positive (C4d+ve). Positive staining in lower proportion of staining would be classified as C4d-ve. This retrospective study evaluated the prognostic value of C4d+ve using a less stringent definition (one C4d+ve glomerulus) in Thai patients with IgAN (n = 120). Baseline findings and outcomes were compared between those with more extensive C4d staining patterns and those with more restricted staining. Clinico-pathologic parameters and risk for kidney outcomes (kidney failure or decline GFR50%) were compared between C4d+ve versus C4d-ve, and between different patterns: Focal (< 50%) versus Diffuse (≥ 50% of glomeruli); or Global (≥ 50) versus Segmental (< 50% of mesangial area). The hazard ratios were estimated using Cox proportional hazard models for Model 1 (Oxford score+ C4d) and Model 2 (Model 1+ clinical factors). C4d+ve (n = 81) had lower eGFR, more global sclerosis, and interstitial fibrosis than C4d-ve at baseline. The 5-year kidney survival for C4d+ve was lower (53.7%) than C4d-ve (89.7%); P = 0.0255. By univariate analysis, T1, T2, C4d+ve, eGFR<60, proteinuria were predictors of kidney outcome. By multivariate analysis, proteinuria, T1, T2 and C4d+ve were independent predictors (Model 2 HR (95% CI) C4d+ve: 3.24 (1.09-9.58), p = 0.034). Segmental had lower eGFR, higher tubulointerstitial fibrosis, and segmental sclerosis compared to Global pattern. Clinicopathological parameters were not different between Focal and Diffuse patterns. Outcomes were similar between staining patterns. In conclusion, C4d staining may be a valuable marker of poor prognosis in Asian patients with IgAN. Less stringent criteria for C4d+ve should be considered as no differences in outcomes were observed between more extensive staining with less extensive patterns. More studies are needed to identify the optimum criteria for C4d+ve.
format	article
author	Suchin Worawichawong Sirithep Plumworasawat Wisit Liwlompaisan Vasant Sumethkul Bunyong Phakdeekitcharoen Umaporn Udomsubpayakul Panus Chalermsanyakorn Chagriya Kitiyakara
author_facet	Suchin Worawichawong Sirithep Plumworasawat Wisit Liwlompaisan Vasant Sumethkul Bunyong Phakdeekitcharoen Umaporn Udomsubpayakul Panus Chalermsanyakorn Chagriya Kitiyakara
author_sort	Suchin Worawichawong
title	Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.
title_short	Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.
title_full	Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.
title_fullStr	Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.
title_full_unstemmed	Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.
title_sort	distribution pattern of mesangial c4d deposits as predictor of kidney failure in iga nephropathy.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6d3102b080a7423e8ca1d0452ef9ef0a
work_keys_str_mv	AT suchinworawichawong distributionpatternofmesangialc4ddepositsaspredictorofkidneyfailureiniganephropathy AT sirithepplumworasawat distributionpatternofmesangialc4ddepositsaspredictorofkidneyfailureiniganephropathy AT wisitliwlompaisan distributionpatternofmesangialc4ddepositsaspredictorofkidneyfailureiniganephropathy AT vasantsumethkul distributionpatternofmesangialc4ddepositsaspredictorofkidneyfailureiniganephropathy AT bunyongphakdeekitcharoen distributionpatternofmesangialc4ddepositsaspredictorofkidneyfailureiniganephropathy AT umapornudomsubpayakul distributionpatternofmesangialc4ddepositsaspredictorofkidneyfailureiniganephropathy AT panuschalermsanyakorn distributionpatternofmesangialc4ddepositsaspredictorofkidneyfailureiniganephropathy AT chagriyakitiyakara distributionpatternofmesangialc4ddepositsaspredictorofkidneyfailureiniganephropathy
_version_	1718374951490158592

Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy.

Ejemplares similares