Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis

Background and Objectives: Glomerular C4d deposits are associated the severity and outcomes of IgA nephropathy. Whether this holds true in immunoglobulin A vasculitis (IgAV) is not known. The main objective of the study was to analyze the prognostic value of glomerular C4d immunolabelling on kidney...

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Autores principales:	Anais Romero, Fanny Drieux, Arnaud François, Alexandra Dervaux, Xiao Li Xu, Dimitri Titeca-Beauport, Dominique Bertrand, Dominique Guerrot
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	immunoglobulin A (IgA) vasculitis glomerulonephritis Henoch-Schönlein purpura immunohistochemistry proteinuria (MeSH: D011507) Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/9b59406f79eb40c180e0f696beb4b15d
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spelling	oai:doaj.org-article:9b59406f79eb40c180e0f696beb4b15d2021-12-01T12:25:38ZPrognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis2296-858X10.3389/fmed.2021.735775https://doaj.org/article/9b59406f79eb40c180e0f696beb4b15d2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.735775/fullhttps://doaj.org/toc/2296-858XBackground and Objectives: Glomerular C4d deposits are associated the severity and outcomes of IgA nephropathy. Whether this holds true in immunoglobulin A vasculitis (IgAV) is not known. The main objective of the study was to analyze the prognostic value of glomerular C4d immunolabelling on kidney impairment in adults with IgAV.Design, Setting, Participants, Measurements: This retrospective cohort study included 120 adults with IgAV and a kidney biopsy performed between 1995 and 2018 in two French university hospital centers. All paraffin-embedded biopsies were reassessed according to Oxford classification. Immunofluorescence for C4d was performed in all cases. For analysis, patients were grouped according to positivity for C4d in the glomerular area. The main outcome was a composite endpoint of 50% increase in 24 h-proteinuria, or eGFR decrease by 50%, or kidney replacement therapy.Results: The median follow-up was 28.3 months. Twenty-three patients met the composite endpoint, 12 for kidney replacement therapy, 6 for an eGFR decrease >50% and 5 for a >50% increase in proteinuria. At time of biopsy, the median proteinuria was 1.9 g/24 h and the median eGFR 73.5 mL/min/1.73 m2. Among the 102 patients evaluable for C4d, 24 were positive on >30% glomeruli, mainly with a parieto-mesangial pattern. In this group, the initial proteinuria was more frequently nephrotic than in the C4d– group (60% vs. 33%, P = 0.039). Mesangial hypercellularity was more frequent in the C4d+ group (42% vs. 13%; P = 0.006) whereas macroscopic hematuria was more frequent in the C4d– group (18% vs. 0%; P = 0.03). After a median follow-up of 28 months, kidney survival did not differ according to C4d status.Conclusion: In a population of adult IgAV patients, glomerular positivity for C4d was associated with the severity of the kidney disease at presentation, but not with subsequent renal function deterioration.Anais RomeroFanny DrieuxArnaud FrançoisAlexandra DervauxXiao Li XuDimitri Titeca-BeauportDominique BertrandDominique GuerrotDominique GuerrotFrontiers Media S.A.articleimmunoglobulin A (IgA)vasculitisglomerulonephritisHenoch-Schönlein purpuraimmunohistochemistryproteinuria (MeSH: D011507)Medicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	immunoglobulin A (IgA) vasculitis glomerulonephritis Henoch-Schönlein purpura immunohistochemistry proteinuria (MeSH: D011507) Medicine (General) R5-920
spellingShingle	immunoglobulin A (IgA) vasculitis glomerulonephritis Henoch-Schönlein purpura immunohistochemistry proteinuria (MeSH: D011507) Medicine (General) R5-920 Anais Romero Fanny Drieux Arnaud François Alexandra Dervaux Xiao Li Xu Dimitri Titeca-Beauport Dominique Bertrand Dominique Guerrot Dominique Guerrot Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis
description	Background and Objectives: Glomerular C4d deposits are associated the severity and outcomes of IgA nephropathy. Whether this holds true in immunoglobulin A vasculitis (IgAV) is not known. The main objective of the study was to analyze the prognostic value of glomerular C4d immunolabelling on kidney impairment in adults with IgAV.Design, Setting, Participants, Measurements: This retrospective cohort study included 120 adults with IgAV and a kidney biopsy performed between 1995 and 2018 in two French university hospital centers. All paraffin-embedded biopsies were reassessed according to Oxford classification. Immunofluorescence for C4d was performed in all cases. For analysis, patients were grouped according to positivity for C4d in the glomerular area. The main outcome was a composite endpoint of 50% increase in 24 h-proteinuria, or eGFR decrease by 50%, or kidney replacement therapy.Results: The median follow-up was 28.3 months. Twenty-three patients met the composite endpoint, 12 for kidney replacement therapy, 6 for an eGFR decrease >50% and 5 for a >50% increase in proteinuria. At time of biopsy, the median proteinuria was 1.9 g/24 h and the median eGFR 73.5 mL/min/1.73 m2. Among the 102 patients evaluable for C4d, 24 were positive on >30% glomeruli, mainly with a parieto-mesangial pattern. In this group, the initial proteinuria was more frequently nephrotic than in the C4d– group (60% vs. 33%, P = 0.039). Mesangial hypercellularity was more frequent in the C4d+ group (42% vs. 13%; P = 0.006) whereas macroscopic hematuria was more frequent in the C4d– group (18% vs. 0%; P = 0.03). After a median follow-up of 28 months, kidney survival did not differ according to C4d status.Conclusion: In a population of adult IgAV patients, glomerular positivity for C4d was associated with the severity of the kidney disease at presentation, but not with subsequent renal function deterioration.
format	article
author	Anais Romero Fanny Drieux Arnaud François Alexandra Dervaux Xiao Li Xu Dimitri Titeca-Beauport Dominique Bertrand Dominique Guerrot Dominique Guerrot
author_facet	Anais Romero Fanny Drieux Arnaud François Alexandra Dervaux Xiao Li Xu Dimitri Titeca-Beauport Dominique Bertrand Dominique Guerrot Dominique Guerrot
author_sort	Anais Romero
title	Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis
title_short	Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis
title_full	Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis
title_fullStr	Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis
title_full_unstemmed	Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis
title_sort	prognostic value of c4d immunolabelling in adult patients with iga vasculitis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/9b59406f79eb40c180e0f696beb4b15d
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Prognostic Value of C4d Immunolabelling in Adult Patients With IgA Vasculitis

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