ISSN: 2251-8363    eISSN: 2251-8819  
J Nephropathol. 2015;4(1):19-23.
doi:10.12860/jnp.2015.04
PMID: 25657981
PMCID: PMC4316581

Scopus id: 84925063879

Original Article

Association of glomerular C4d deposition with various demographic data in IgA nephropathy patients; a preliminary study

Hamid Nasri 1, Ali Ahmadi 2, Mahmood Rafieian-kopaei 3, Bahman Bashardoust 4, Parto Nasri 5, Muhammed Mubarak 6 *

1 Department of Nephrology, Division of Nephropathology, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Medical Plants Research Center, Shahrekord University of Medical Sciences, Sharhekord, Iran
4 Department of Internal Medicine, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
5 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
6 Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
Corresponding author: Prof. Muhammed Mubarak, Histopathology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Email: drmubaraksiut@yahoo.com

Abstract

Background: IgA nephropathy (IgAN) is the most prevalent primary chronic glomerulopathy worldwide. Thus, it is of vital importance to search for factors aggravating the disease progress, monitor disease activity and predict disease-specific therapy. C4d is a well-known biomarker of the complement cascade with a potential to meet the above needs.

Objectives: The aim of our study was, therefore, to determine whether C4d staining at the time of kidney biopsy had any correlation with the demographic, clinical and biochemical variables in IgAN.

Patients and Methods: The definition of IgAN requires the presence of diffuse and global IgA deposits which were graded ≥2+ and weak C1q deposition. C4d immunohistochemical staining was conducted retrospectively on 29 renal biopsies of patients with IgAN, which were selected randomly from all biopsies. C4d immunohistochemical staining was performed on 3-μm deparaffinized and rehydrated sections of formaldehyde-fixed, paraffin-embedded renal tissues.

Results: Of 29 selected patients, 68% were male. In this study, 54.2±25 percent of glomeruli in all biopsies were positive for C4d. The mean and standard deviation (SD) of serum creatinine and the magnitude of proteinuria were 1.72±1.2 mg/dl and 1582±1214 mg/day, respectively. In this study, we observed statistically significant correlations of percent C4d positivity with the serum creatinine (r=0.61, p=0.0005), magnitude of proteinuria (r=0.72, p=0.0001), the proportion of globally sclerotic glomeruli (r=0.43, p=0.02) and the proportion of tubulointerstitial fibrosis (r=0.54, p=0.0023).

Conclusions: The results from our investigation on C4d positivity in biopsy-proven cases of IgAN are in accord with some of the previous studies. These findings, however, require further validation in larger samples.

Implication for health policy/practice/research/medical education:

In a study on 29 selected IgA nephropathy patients , we found that C4d immunostaining has a significant positive correlation with serum creatinine, level of proteinuria, proportion of globally sclerotic glomeruli and quantity of tubulointerstitial fibrosis in patients with IgAN. Staining for C4d could be incorporated into the routine analysis of kidney biopsies in patients with IgAN, given its prognostic implication. Our findings, however, require further investigation with larger samples.

Please cite this paper as: Nasri H, Ahmadi A, Rafieian-kopaei M, Bashardoust B, Nasri P, Mubarak M. Association of glomerular C4d deposition with various demographic data in IgA nephropathy patients; a preliminary study. J Nephropathol 2015; 4(1):19-23. DOI: 10.12860/jnp.2015.04

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