| Objective To investigate the effect of glomerular C4d deposition on the prognosis of patients with IgA nephropathy and the variation of glomerular filtration rate in patients with IgA nephropathy.Methods From January 1,2011 to June 1,2019,a total 191 primary IgAN patients were Continuous retrospective Collected in the department of Shenzhen Second People’s Hospital,who were performed firstly with renal biopsy.Immunohistochemical C4d staining was performed on renal needle pathological tissue sections,and observes the positive rate,distribution and regional characteristics of C4d deposition.According to the C4d deposition,they were divided into glomerular C4d negative group and positive group.The renal composite end point of the study was a decrease in e GFR more than 30%or entry into ESRD.Kaplan-Meier survival curve analysis was used to compare the renal progression rate between the two groups.Univariate and multivariate Cox regression were used to analyze the effect of glomerular C4d deposition on renal prognosis in patients with IgAN.The effect of glomerular C4d deposition on renal prognosis of IgAN patients in different populations was explored by layered interaction analysis.The effects of C4d deposition on the variation of glomerular filtration rate in patients with IgA nephropathy were analyzed by generalized additive mixed model.Results(1)A total of 191 primary IgAN patients were included according to the exclusion criteria,including 124 cases of glomerular C4d negative group and 67 cases of glomerular C4d positive group.Males accounted for 50.3%;The mean age was(35.2±9.2)years,and the mean follow-up time was(21.98±18.28)months.A total of 27 patients entered the end point event,accounting for 14.14%of the total patients,including 16 cases(12.90%)in the glomerular C4d negative group,and 11 cases(16.42%)in the glomerular C4d positive group.(2)Comparison of the characteristics of baseline clinical data between the two groups showed that the indexes of serum calcium,serum albumin,serum Ig G and e GFR in the C4d positive group were lower than the negative group(P<0.05).In addition,in the baseline pathological data of the two groups,capillary hyperplasia(E)(E1 accounted for 16.13%in the C4d negative group and 31.34%in the C4d positive group)(P=0.015),and the difference was statistically significant.(3)In univariate Cox analysis,serum potassium,blood chlorine,blood phosphorus,urinary protein,segmental sclerosis,crescent(C),interstitial inflammatory cell infiltration,renal tubule atrophy,interstitial fibrosis,and tubule atrophy/interstitial fibrosis(T)were risk factors for the occurrence of renal end events of IgAN.In addition,hemoglobin,blood carbon dioxide binding force,total blood protein,blood albumin,and red blood cell count are protective factors for the occurrence of IgAN renal endpoint events.(4)In multivariate Cox analysis,positive glomerular C4d deposition[HR=0.53,95%CI(0.17,1.66),P=0.273]was observed after adjustment for gender,age,e GFR,body mass index,SBP,urinary protein,Oxford grade(C,M,E,S,T),use of ACEI/ARB,use of glucocorticoids,and use of immunosuppression had no significant on the occurrence of renal endpoint events of IgAN.(5)In Kaplan-Meier survival curve analysis,the 3 and 6 years renal survival rate of glomerular C4d negative group was 80.61%and 56.14%,respectively;The renal survival rate at 3 and 6years in the glomerular C4d positive group was 78.73%and 38.49%,respectively.However,there was no significant difference between the two groups(P=0.530).(6)In layered interaction analysis,glomerular C4d deposition of IgAN kidney end point event is not affected by the influence of sex,body mass index,hemoglobin,urine protein,blood albumin quantitative,systolic blood pressure,e GFR,using Angiotension converting enzyme inhibitors(ACEI)/Angiotension receptor blocker(ARB),using glucocorticoid and use of immunosuppressant(P>0.05),the influence of such factors as the results are stable.(7)In the analysis of the generalized additive mixed model,the mean e GFR decreased by3.875ml/min/1.73m~2in the C4d deposit-negative group for every 1 year,and the e GFR increased by 5.694ml/min/1.73m~2in the glomerular C4d-positive group compared with the glomerular C4d-negative group.However,there was no significant difference between the two groups(P=0.278).Conclusion In our study,glomerular C4d deposition was not significantly associated with renal outcomes in patients with IgAN,and stratified cross-analysis showed that this outcome was stable in different populations.Glomerular C4d deposition had no significant effect on glomerular filtration rate in IgAN patients. |
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