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Characteristics of membranoproliferative glomerulonephritis based on a new classification at a single center

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A Correction to this article was published on 03 September 2019

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Abstract

Background

Recently, a new classification has been established for membranoproliferative glomerulonephritis (MPGN). However, the effect of the new classification on MPGN treatment is not fully understood.

Methods

We conducted a retrospective study of 87 patients with biopsies diagnosed as MPGN. We reclassified 87 MPGN patients diagnosed between 1977 and 2014 at our hospital, according to the new classification, and analyzed both primary immune complex (IC)- and complement (CP)-mediated MPGN in terms of clinicopathological features, treatment, and renal prognosis.

Results

Proteinuria was abundant in the IC-mediated MPGN group (p = 0.0063), and the serum albumin level was significantly lower in the IC-mediated MPGN group (p = 0.0186). The serum C3 value was significantly lower in the CP-mediated MPGN group (p = 0.0317). Serum CH50 values were also lower in the CP-mediated MPGN group (p = 0.0404). However, glomerular deposition of C3 showed no significant differences in immunofluorescence findings. The 148.6-month renal survival rate was similar in both groups (p = 0.445).

Conclusion

These results suggested no significant differences in complement activation of the solid phase in local glomeruli and therefore no equivalence in renal prognosis.

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Change history

  • 03 September 2019

    In the Original publication, the authors found few errors in the text.

References

  1. Masani N, Jhaveri KD, Fishbane S. Update on membranoproliferative GN. Clin J Am Soc Nephrol. 2014;9(3):600–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sugiyama H, Yokoyama H, Sato H, Saito T, Kohda Y, Nishi S, Tsuruya K, Kiyomoto H, Iida H, Sasaki T, Higuchi M, Hattori M, Oka K, Kagami S, Nagata M, Kawamura T, Honda M, Fukasawa Y, Fukatsu A, Morozumi K, Yoshikawa N, Yuzawa Y, Matsuo S, Kiyohara Y, Joh K, Taguchi T, Makino H. Committee for standardization of renal pathological diagnosis and Working Group for Renal Biopsy Database, Japanese Society of Nephrology, Tokyo, Japan. Japan Renal Biopsy Registry: the first nationwide, web-based, and prospective registry system of renal biopsies in Japan. Clin Exp Nephrol. 2011;15(4):493–503.

    Article  PubMed  Google Scholar 

  3. Takei T, Itabashi M, Moriyama T, Shimizu A, Tsuruta Y, Ochi A, Nakayama K, Iwasaki C, Uchida K, Nitta K. Positive C1q staining associated with poor renal outcome in membranoproliferative glomerulonephritis. Clin Exp Nephrol. 2013;17(1):92–8.

    Article  CAS  PubMed  Google Scholar 

  4. Sethi S, Nester CM, Smith RJ. Membranoproliferative glomerulonephritis and C3 glomerulopathy: resolving the confusion. Kidney Int. 2012;81(5):434–41.

    Article  PubMed  Google Scholar 

  5. Sethi S, Fervenza FC. Membranoproliferative glomerulonephritis: pathogenetic heterogeneity and proposal for a new classification. Semin Nephrol. 2011;31(4):341–8.

    Article  CAS  PubMed  Google Scholar 

  6. Sethi S, Fervenza FC. Membranoproliferative glomerulonephritis—a new look at an old entity. N Engl J Med. 2012;366(12):1119–31.

    Article  CAS  PubMed  Google Scholar 

  7. Bomback AS, Appel GB. Pathogenesis of the C3 glomerulopathies and reclassification of MPGN. Nat Rev Nephrol. 8(11):634–42.

  8. Hou J, Markowitz GS, Bomback AS, Appel GB, Herlitz LC, Barry Stokes M, D’Agati VD. Toward a working definition of C3 glomerulopathy by immunofluorescence. Kidney Int. 2014;85(2):450–6.

    Article  CAS  PubMed  Google Scholar 

  9. Cook HT, Pickering MC. Clusters not classifications: making sense of complement-mediated kidney injury. J Am Soc Nephrol. 2018;29(1):9–12.

    Article  CAS  PubMed  Google Scholar 

  10. Fervenza FC, Sethi S, Glassock RJ. Idiopathic membranoproliferative glomerulonephritis: does it exist? Nephrol Dial Transplant. 2012;27(12):4288–94.

    Article  CAS  PubMed  Google Scholar 

  11. Nakagawa N, Hasebe N, Hattori M, Nagata M, Yokoyama H, Sato H, Sugiyama H, Shimizu A, Isaka Y, Maruyama S, Narita I. Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015. Clin Exp Nephrol. 2018;22(4):797–807.

    Article  PubMed  Google Scholar 

  12. Mathern DR, Heeger PS. Molecules great and small: the complement system. Clin J Am Soc Nephrol. 2015;10(9):1636–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sheerin NS, Springall T, Carroll M, Sacks SH. Altered distribution of intraglomerular immune complexes in C3-deficient mice. Immunology. 1999;97(3):393–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Clynes R, Dumitru C, Ravetch JV. Uncoupling of immune complex formation and kidney damage in autoimmune glomerulonephritis. Science. 1998;279(5353):1052–4.

    Article  CAS  PubMed  Google Scholar 

  15. Meyer-Schwesinger C, Dehde S, Klug P, Becker JU, Mathey S, Arefi K, Balabanov S, Venz S, Endlich KH, Pekna M, Gessner JE, Thaiss F, Meyer TN. Nephrotic syndrome and subepithelial deposits in a mouse model of immune-mediated anti-podocyte glomerulonephritis. J Immunol. 2011;187(6):3218–29.

    Article  CAS  PubMed  Google Scholar 

  16. Iatropoulos P, Daina E, Curreri M, Piras R, Valoti E, Mele C, Bresin E, Gamba S, Alberti M, Breno M, Perna A, Bettoni S, Sabadini E, Murer L, Vivarelli M, Noris M, Remuzzi G. Registry of membranoproliferative glomerulonephritis/C3 glomerulopathy; Nastasi. Cluster analysis identifies distinct pathogenetic patterns in C3 glomerulopathies/immune complex-mediated membranoproliferative GN. J Am Soc Nephrol. 2018;29(1):283–94.

    Article  CAS  PubMed  Google Scholar 

  17. Barbour TD, Pickering MC, Cook HT. Recent insights into C3 glomerulopathy. Nephrol Dial Transplant. 2013;28(7):1685–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Servais A, Noël LH, Roumenina LT, Le Quintrec M, Ngo S, Dragon-Durey MA, Macher MA, Zuber J, Karras A, Provot F, Moulin B, Grünfeld JP, Niaudet P, Lesavre P, Frémeaux-Bacchi V. Acquired and genetic complement abnormalities play a critical role in dense deposit disease and other C3 glomerulopathies. Kidney Int. 2012;82(4):454–64.

    Article  CAS  PubMed  Google Scholar 

  19. Ito N, Ohashi R, Nagata M. C3 glomerulopathy and current dilemmas. Clin Exp Nephrol. 2017;21(4):541–51.

    Article  CAS  PubMed  Google Scholar 

  20. Zhang Y, Nester CM, Martin B, Skjoedt MO, Meyer NC, Shao D, Borsa N, Palarasah Y, Smith RJ. Defining the complement biomarker profile of C3 glomerulopathy. Clin J Am Soc Nephrol. 2014;9(11):1876–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bomback AS, Santoriello D, Avasare RS, Regunathan-Shenk R, Canetta PA, Ahn W, Radhakrishnan J, Marasa M, Rosenstiel PE, Herlitz LC, Markowitz GS, D’Agati VD, Appel GB. C3 glomerulonephritis and dense deposit disease share a similar disease course in a large United States cohort of patients with C3 glomerulopathy. Kidney Int. 2018;93(4):977–85.

    Article  PubMed  Google Scholar 

  22. Sethi S, Fervenza FC, Zhang Y, Zand L, Vrana JA, Nasr SH, Theis JD, Dogan A, Smith RJ. C3 glomerulonephritis: clinicopathological findings, complement abnormalities, glomerular proteomic profile, treatment, and follow-up. Kidney Int. 2012;82(4):465–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Iatropoulos P, Noris M, Mele C, Piras R, Valoti E, Bresin E, Curreri M, Mondo E, Zito A, Gamba S, Bettoni S, Murer L, Fremeaux-Bacchi V, Vivarelli M, Emma F, Daina E, Remuzzi G. Complement gene variants determine the risk of immunoglobulin-associated MPGN and C3 glomerulopathy and predict long-term renal outcome. Mol Immunol. 2016;71:131–42.

    Article  CAS  PubMed  Google Scholar 

  24. Levin A. Management of membranoproliferative glomerulonephritis: evidence-based recommendations. Kidney Int Suppl. 1999;70:41-6.

    Google Scholar 

  25. Faedda R, Satta A, Tanda F, Pirisi M, Bartoli E. Immunosuppressive treatment of membranoproliferative glomerulonephritis. Nephron. 1994;67(1):59–65.

    Article  CAS  PubMed  Google Scholar 

  26. Imtiaz S, Dhrolia MF, Nasir K, Salman B, Ahmad A. Type of immune and complement deposits and response of immunosuppressive treatment on membranoproliferative glomerulonephritis—a single centre experience. J Pak Med Assoc. 2015;65(9):995–1000.

    PubMed  Google Scholar 

  27. Braun MC, West CD, Strife CF. Differences between membranoproliferative glomerulonephritis types I and III in long-term response to an alternate-day prednisone regimen. Am J Kidney Dis. 1999;34(6):1022–32.

    Article  CAS  PubMed  Google Scholar 

  28. Radhakrishnan S, Lunn A, Kirschfink M, Thorner P, Hebert D, Langlois V, Pluthero F, Licht C. Eculizumab and refractory membranoproliferative glomerulonephritis. N Engl J Med. 2012;366(12):1165–6.

    Article  CAS  PubMed  Google Scholar 

  29. Herlitz LC, Bomback AS, Markowitz GS, Stokes MB, Smith RN, Colvin RB, Appel GB, D’Agati VD. Pathology after eculizumab in dense deposit disease and C3 GN. J Am Soc Nephrol. 2012;23(7):1229–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Mizuno M, Suzuki Y, Ito Y. Complement regulation and kidney diseases: recent knowledge of the double-edged roles of complement activation in nephrology. Clin Exp Nephrol. 2018;22(1):3–14.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Mitchell Arico from Edanz Group (http://www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Marie Nakano, Kazunori Karasawa, Takahito Moriyama, Keiko Uchida & Kosaku Nitta

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  1. Marie Nakano
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  2. Kazunori Karasawa
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  3. Takahito Moriyama
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  4. Keiko Uchida
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  5. Kosaku Nitta
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Correspondence to Kazunori Karasawa.

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This study complied with the guidelines of the Declaration of Helsinki and was approved by our institutional ethics committee (#4370). We received oral consent from all patients and we providing the patients with the opportunity to Opt Out.

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Nakano, M., Karasawa, K., Moriyama, T. et al. Characteristics of membranoproliferative glomerulonephritis based on a new classification at a single center. Clin Exp Nephrol 23, 852–858 (2019). https://doi.org/10.1007/s10157-019-01716-7

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