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Clinical relevance of membrane attack complex deposition in children with IgA nephropathy and Henoch-Schönlein purpura.
- Source :
-
Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2020 May; Vol. 35 (5), pp. 843-850. Date of Electronic Publication: 2020 Jan 13. - Publication Year :
- 2020
-
Abstract
- Background: IgA nephropathy (IgAN) and Henoch-Schönlein purpura are common glomerular disorders in children sharing the same histopathologic pattern of IgA deposits within the mesangium, even if their physiopathology may be different. Repeated exposure to pathogens induces the production of abnormal IgA1. The immune complex deposition in the renal mesangium in IgAN or potentially in small vessels in Henoch-Schönlein purpura induces complement activation via the alternative and lectin pathways. Recent studies suggest that levels of membrane attack complex (MAC) in the urine might be a useful indicator of renal injury. Because of the emerging availability of therapies that selectively block complement activation, the aim of the present study is to investigate whether MAC immunostaining might be a useful marker of IgA-mediated renal injury.<br />Methods: We conducted immunohistochemistry analysis of the MAC on renal biopsies from 67 pediatric patients with IgAN and Henoch-Schönlein purpura. We classified their renal biopsies according to the Oxford classification, retrieved symptoms, biological parameters, treatment, and follow-up.<br />Results: We found MAC expression was significantly related to impaired renal function and patients whose clinical course required therapy. MAC deposits tend to be more abundant in patients with decreased glomerular filtration rate (p = 0.02), patients with proteinuria > 0.750 g/day/1.73 m <superscript>2</superscript> , and with nephrotic syndrome. No correlation with histological alterations was observed.<br />Conclusions: We conclude that MAC deposition could be a useful additional indicator of renal injury in patients with IgAN and Henoch-Schönlein purpura, independent of other indicators.
- Subjects :
- Adolescent
Biomarkers analysis
Biopsy
Child
Child, Preschool
Complement Membrane Attack Complex immunology
Complement Pathway, Alternative drug effects
Complement Pathway, Alternative immunology
Complement Pathway, Mannose-Binding Lectin drug effects
Complement Pathway, Mannose-Binding Lectin immunology
Feasibility Studies
Female
Follow-Up Studies
Glomerular Mesangium immunology
Glomerulonephritis, IGA drug therapy
Glomerulonephritis, IGA immunology
Glomerulonephritis, IGA pathology
Humans
IgA Vasculitis drug therapy
IgA Vasculitis immunology
IgA Vasculitis pathology
Immunoglobulin A immunology
Immunosuppressive Agents pharmacology
Male
Prognosis
Retrospective Studies
Treatment Outcome
Complement Membrane Attack Complex analysis
Glomerular Mesangium pathology
Glomerulonephritis, IGA diagnosis
IgA Vasculitis diagnosis
Immunosuppressive Agents therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1432-198X
- Volume :
- 35
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Pediatric nephrology (Berlin, Germany)
- Publication Type :
- Academic Journal
- Accession number :
- 31932958
- Full Text :
- https://doi.org/10.1007/s00467-019-04445-x