Could mesangial C3 deposition be an independent prognostic marker in immunoglobulin A nephropathy?

Nov 13, 2023

Experts: Hakki Cetinkaya,Meltem Gursu,Halil Yazici,Egemen Cebeci,Necmi Eren,Mehmet Riza Altiparmak,Omer Faruk Akcay,Gulizar Sahin,Hamad Dheir,Taner Basturk,Kadir Gokhan Atilgan,Nihal Aydemir,Kenan Turgutalp,Murvet Yilmaz,Semahat Karahisar Sirali,Erhan Tatar,Elif Gullulu Boz,Safak Mirioglu,Sinan Kazan,Emre Aydin,Zeki Aydin,Kultigin Turkmen,Sim Kutlay,Ferdi Karagoz,Melike Betul Ogutmen,Savas Ozturk,Oktay Ozkan,Nuriye Yildiz,Tamer Dincer,Emre Yasar,Mahmut Gok,Aydın Turkmen,Fatih Dede,Ulver Derici

Immunoglobulin A nephropathy (IgAN) is a common primary glomerulonephropathy. There is evidence that mesangial C3 deposition plays a role in the development of the disease. The aim of this study was to examine the effect of C3 deposition on the prognosis of IgAN patients.
The study included 1135 patients with biopsy-confirmed IgAN from the database of the Turkish Nephrology Association Glomerular Diseases Working Group (TSN-GOLD). Patients were excluded from the study if they were aged 75 years or if C3 staining had not been performed in the immunofluorescent analysis. C3 deposition was defined as an immunofluorescence intensity of C3 ≥ 2 + within the mesangium. The primary endpoints were the development of end-stage renal disease, a 30% decrease in glomerular filtration rate compared to the basal value or an elevation in proteinuria to a nephrotic level (3.5 gr/day).
Mesangial C3 deposition was observed in 603 (53.1%) patients. No statistically significant difference was found at baseline between the groups with and without mesangial C3 deposition, as for age, sex, BMI, proteinuria level, or the presence of hypertension. In the follow-up period with a mean duration of 78 months, no significant difference was found between the two groups regarding the primary endpoints (p = 0.43). A significant correlation between C3 deposition and segmental glomerulosclerosis (S1) according to the Oxford MEST-C classification was found (p = 0.001).
Although a correlation was observed between mesangial C3 deposition and the S1 MEST-C classification, mesangial C3 deposition was not a prognostic factor in IgAN.

© 2023. The Author(s) under exclusive licence to Italian Society of Nephrology.

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ABOUT THE EXPERTS

Hakki Cetinkaya,Meltem Gursu,Halil Yazici,Egemen Cebeci,Necmi Eren,Mehmet Riza Altiparmak,Omer Faruk Akcay,Gulizar Sahin,Hamad Dheir,Taner Basturk,Kadir Gokhan Atilgan,Nihal Aydemir,Kenan Turgutalp,Murvet Yilmaz,Semahat Karahisar Sirali,Erhan Tatar,Elif Gullulu Boz,Safak Mirioglu,Sinan Kazan,Emre Aydin,Zeki Aydin,Kultigin Turkmen,Sim Kutlay,Ferdi Karagoz,Melike Betul Ogutmen,Savas Ozturk,Oktay Ozkan,Nuriye Yildiz,Tamer Dincer,Emre Yasar,Mahmut Gok,Aydın Turkmen,Fatih Dede,Ulver Derici

Hakki Cetinkaya

Department of Nephrology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey. drhcetinkaya@gmail.com.

Meltem Gursu

Medical Faculty, Nephrology, Bezmialem Vakif University, Istanbul, Turkey.

Halil Yazici

Istanbul Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey.

Egemen Cebeci

Department of Nephrology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Necmi Eren

Medical Faculty, Nephrology, Kocaeli University, Izmit, Kocaeli, Turkey.

Mehmet Riza Altiparmak

Cerrahpasa Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey.

Omer Faruk Akcay

Medical Faculty, Nephrology, Gazi University, Ankara, Turkey.

Gulizar Sahin

Department of Nephrology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Hamad Dheir

Medical Faculty, Nephrology, Sakarya University, Adapazari, Sakarya, Turkey.

Taner Basturk

Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Kadir Gokhan Atilgan

Department of Nephrology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Nihal Aydemir

Department of Nephrology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey.

Kenan Turgutalp

Division of Nephrology, Department of Internal Medicine, Mersin University School of Medicine, Mersin, Turkey.

Murvet Yilmaz

Department of Nephrology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Semahat Karahisar Sirali

Department of Nephrology, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Erhan Tatar

Department of Nephrology, Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey.

Elif Gullulu Boz

Division of Nephrology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey.

Safak Mirioglu

Medical Faculty, Nephrology, Bezmialem Vakif University, Istanbul, Turkey.

Sinan Kazan

Department of Nephrology, Afyonkarahisar School of Medicine, University of Health Sciences, Afyonkarahisar, Turkey.

Emre Aydin

Medical Faculty, Nephrology, Dicle University, Diyarbakir, Turkey.

Zeki Aydin

Department of Nephrology, Darica Farabi Training and Research Hospital, University of Health Sciences, Darica, Kocaeli, Turkey.

Kultigin Turkmen

Meram Medical Faculty, Nephrology, Necmettin Erbakan University, Konya, Turkey.

Sim Kutlay

Medical Faculty, Nephrology, Ankara University, Ankara, Turkey.

Ferdi Karagoz

Medical Faculty, Nephrology, Trakya University, Edirne, Turkey.

Melike Betul Ogutmen

Department of Nephrology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Savas Ozturk

Istanbul Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey.

Oktay Ozkan

Department of Nephrology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Nuriye Yildiz

Medical Faculty, Nephrology, Kocaeli University, Izmit, Kocaeli, Turkey.

Tamer Dincer

Cerrahpasa Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey.

Emre Yasar

Medical Faculty, Nephrology, Gazi University, Ankara, Turkey.

Mahmut Gok

Department of Nephrology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Aydın Turkmen

Istanbul Medical Faculty, Nephrology, Istanbul University, Istanbul, Turkey.

Fatih Dede

Department of Nephrology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey.

Ulver Derici

Medical Faculty, Nephrology, Gazi University, Ankara, Turkey.