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Clinical significance of IgM and C3 deposition in children with primary immunoglobulin A nephropathy

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Abstract

Background

Mesangial IgM and C3 deposition is commonly observed in patients with primary immunoglobulin A nephropathy (IgAN), but its characteristics and prognosis have rarely been reported. The aim of this study was to investigate the relationship between combined mesangial IgM and C3 deposition and disease progression in children with IgAN.

Methods

One hundred sixteen children diagnosed with IgAN between 2016 and 2020 were selected. Renal biopsies were scored by Oxford classification including the presence of mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis, tubular atrophy/interstitial fibrosis and crescents. The primary renal outcome was an event of either ≥ 50% reduction of eGFR from the baseline value or the onset of end-stage renal disease within the follow-up period. Cox regression analysis was performed to examine the effect of the combined mesangial IgM and C3 deposition on renal outcomes.

Results

Forty-seven (40.52%) patients presented combined mesangial IgM and C3 deposition. Compared with children without combined IgM and C3 deposition, children with combined IgM and C3 deposition presented higher mesangial hypercellularity, endocapillary hypercellularity and cresentic lesions in kidney biopsies, and higher prevalence of renal dysfunction (19.15% versus 2.90%; P = 0.007). Renal outcome was also significantly worse as revealed by Kaplan–Meier curves (P = 0.0034). Multivariable Cox analysis identified tubular atrophy/interstitial fibrosis lesions [hazard ratio (HR) 14.843, 95% CI, 3.497–62.997, P < 0.001] and intensity of IgM deposition (HR 2.838, 95% CI, 1.321–6.094, P = 0.007) as independent risk factors for poor renal function.

Conclusions

Combined mesangial IgM and C3 deposition was associated with unfavorable histopathological features. Mesangial IgM deposition was an independent risk factor for poor renal outcomes in children with primary IgAN.

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Funding

This work was supported by a grant from the Science and Technology Bureau of Sichuan Province (No. 21ZDYF1329).

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, West China Second University Hospital, Sichuan University, NO. 20, Section 3, Renmin Nan Lu, Chengdu, 610041, China

    Limei Xiong, Lili Liu, Yuhong Tao & Hui Guo

  2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China

    Limei Xiong, Yuhong Tao & Hui Guo

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  1. Limei Xiong
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  2. Lili Liu
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  3. Yuhong Tao
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  4. Hui Guo
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Contributions

All authors contributed to the study design and conception. Material preparation, data collection and analysis were performed by LX, LL and YT. The first draft of this manuscript was written by LX. All authors participated in revising previous versions of the manuscript and have read and approved the final manuscript.

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Correspondence to Hui Guo.

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All data were obtained via electronic medical records and a database review. This study was approved by the Institutional Ethics Committee.

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Xiong, L., Liu, L., Tao, Y. et al. Clinical significance of IgM and C3 deposition in children with primary immunoglobulin A nephropathy. J Nephrol 36, 2213–2222 (2023). https://doi.org/10.1007/s40620-023-01724-7

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  • DOI: https://doi.org/10.1007/s40620-023-01724-7

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