1. Clinical significance of C4d deposition in renal tissues from patients with primary Sjögren’s syndrome—a preliminary study
- Author
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Fa-lei Zheng, Yubing Wen, Lin Duan, Mingxi Li, Yan Li, Wenli Xia, Limeng Chen, Xuemei Li, and Bixia Gao
- Subjects
Adult ,Male ,Nephrology ,medicine.medical_specialty ,Pathology ,Renal involvement ,030232 urology & nephrology ,Primary Sjögren’s syndrome ,030204 cardiovascular system & hematology ,Kidney ,lcsh:RC870-923 ,Glomerulonephritis, Membranous ,Gastroenterology ,Nephropathy ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Membranous nephropathy ,Internal medicine ,Biopsy ,Complement C4b ,medicine ,Humans ,Clinical significance ,Retrospective Studies ,Mannan-binding lectin ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,lcsh:Diseases of the genitourinary system. Urology ,Peptide Fragments ,Sjogren's Syndrome ,Mesangial proliferative glomerulonephritis ,Immunohistochemistry ,C4d deposition ,Female ,Renal biopsy ,business ,Research Article ,Follow-Up Studies ,Glomerular Filtration Rate - Abstract
ObjectivesTo evaluate renal expression of C4d, a complement component in the classical/mannose binding lectin (MBL) pathway, in patients with primary Sjögren’s syndrome (pSS)-associated renal impairments.MethodsWe retrospectively reviewed the clinical and pathological data from 39 patients with pSS presenting with renal impairments. C4d was examined in paraffin-embedded biopsy tissues using immunohistochemistry. Glomerular C4d positive was defined when >75% glomeruli were globally stained. Tubulointerstitial C4d (TI-C4d) were scored semi-quantitatively as 0 (absent), 1 (spotty or weak), 2 (patchy) and 3 (diffuse). A TI-C4d score ≥2 was considered TI-C4d positive and included in the TI-C4d+ group and vice versa. Peritubular capillary (PTC) C4d was scored as 0 (absent), 1 (0∼10%, minimal), 2 (10%∼50%, focal), and 3 (>50%, diffuse).ResultsGlomerular C4d deposition was observed in all 8 patients with pSS-related membranous nephropathy (MN) without obvious C1q deposition. Two of 5 patients with mesangial proliferative glomerulonephritis and 1 of 2 patients with IgA nephropathy had mild mesangial C4d deposition. Sixteen patients (6 glomerular dominant and 10 tubulointerstitial dominant) presented TI-C4d score ≥2. Patients in the TI-C4d+ group exhibited a higher serum creatinine level at the time of renal biopsy (TI-C4d+ 132.5 [89.7, 165.5] vs. TI-C4d- 83.0 [70.7, 102.0] μmol/L, P=0.008). PTC C4d was observed in 12 patients, with each of minimal, focal and diffuse staining being noted in 4 patients.ConclusionsThe MBL pathway of complement activation was potentially involved in pSS-related MN. Tubulointerstitial C4d might be a pathological marker of severe renal injury in patients with pSS-related renal impairments.
- Published
- 2019