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Pediatric Nephrology
Published in: Pediatric Nephrology 7/2017

01-07-2017 | Original Article

Mesangial C4d deposition may predict progression of kidney disease in pediatric patients with IgA nephropathy

Authors: Rafaela Cabral Gonçalves Fabiano, Stanley de Almeida Araújo, Eduardo Alves Bambirra, Eduardo Araújo Oliveira, Ana Cristina Simões e Silva, Sérgio Veloso Brant Pinheiro

Published in: Pediatric Nephrology | Issue 7/2017

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Abstract

Background

Data on the risk factors for chronic kidney disease in children with immunoglobulin A nephropathy (IgAN) are scarce. This study was aimed at investigating whether glomerular C4d immunostaining is a prognostic marker in pediatric IgAN.

Methods

In this retrospective cohort study, 47 patients with IgAN biopsied from 1982 to 2010 were evaluated. Immunohistochemistry for C4d was performed in all cases. For analysis, patients were grouped according to positivity or not for C4d in the mesangial area. Primary outcome was a decline in baseline estimated glomerular filtration rate (eGFR) by 50% or more.

Results

Median follow-up was 8.3 years. Median renal survival was 13.7 years and the probability of a 50% decline in eGFR was 13% over 10 years. Nine children exhibited the primary outcome and 4 developed end-stage renal disease (ESRD). Compared with C4d-negative patients (n = 10), C4d-positive patients (n = 37) presented higher baseline proteinuria (1.66 ± 0.68 vs 0.47 ± 0.19 g/day/1.73 m2, p < 0.001), a progressive decline in eGFR (−10.04 ± 19.38 vs 1.70 ± 18.51 ml/min/1.73 m2/year; p = 0.045), and more frequently achieved the primary outcome (50.0 vs 10.8%, p = 0.013), and ESRD (30.0 vs 2.7%, p = 0.026). No difference was observed in Oxford classification variables. Baseline proteinuria, endocapillary hypercellularity and mesangial C4d deposition were associated with primary outcome in univariate analysis. Proteinuria and mesangial C4d deposition at baseline independently predicted the decline in eGFR. Renal survival was significantly reduced in C4d-positive patients (8.6 vs 15.1 years in C4d-negative patients, p < 0.001).

Conclusions

In this exclusively pediatric cohort, positivity for C4d in the mesangial area was an independent predictor of renal function deterioration in IgAN.
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Metadata
Title
Mesangial C4d deposition may predict progression of kidney disease in pediatric patients with IgA nephropathy
Authors
Rafaela Cabral Gonçalves Fabiano
Stanley de Almeida Araújo
Eduardo Alves Bambirra
Eduardo Araújo Oliveira
Ana Cristina Simões e Silva
Sérgio Veloso Brant Pinheiro
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 7/2017
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-017-3610-y

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