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  • Küçük Resim
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    Could mesangial C3 deposition be an independent prognostic marker in immunoglobulin A nephropathy?
    (Springer Heidelberg, 2023) Çetinkaya, Hakkı; Gürsu, Meltem; Yazıcı, Halil; Cebeci, Egemen; Eren, Necmi; Altıparmak, Mehmet Rıza; Akçay, Ömer Faruk; Aydın, Emre; 0000-0001-9527-3885; 0000-0003-3972-2521; 0000-0003-2526-3483; 0000-0002-7393-5144; 0000-0002-2708-3470; 0000-0001-7657-3065
    Background: 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.Method: 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 < 18 or > 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).Results: 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).Conclusion: 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.
  • Küçük Resim
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    The relationship between glomerular IgG staining and poor prognostic findings in patients with IgA nephropathy: the data from TSN-GOLD working group
    (BioMed Central Ltd, 2021) Turgutalp, Kenan; Cebeci, Egemen; Türkmen, Aydın; Derici, Ülver Boztepe; Seyahi, Nurhan; Eren, Necmi; Dede, Fatih; Güllülü, Mustafa; Baştürk, Taner; Şahin, Gülizar Manga; Yılmaz, Mürvet; Sipahi, Savaş; Şahin, Garip; Ulu, Sena Memnune; Tatar, Erhan; Gündogdu, Ali; Kazancıoğlu, Rümeyza Turan; Sevinç, Can; Güngör, Özkan; Şahin, İdris; Kutlay, Sim; Kurultak, İlhan; Aydın, Zeki; Altun, Bülent; Dursun, Belda; Yılmaz, Zülfükar; Uzun, Özcan; Süleymanlar, Gültekin; Candan, Ferhan; Sezer, Siren; Tanburoğlu, Derya Basak; Bicik, Zerrin; Taymez, Dilek Güven; Akcali, Esra; Oygar, Düriye Deren; İstemihan, Zülal; Bardak, Simge; Bardak, Simge; Akçay, Ömer Faruk; Dincer, Mevlüt Tamer; Dervişoğlu, Erkan; Yenigün, Ezgi Çoşkun; Türkmen, Kültigin; Özturk, Savaş
    Background: Galactose-deficient IgA1 (Gd-IgA1) has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgAN pathogenesis by accumulating in the glomerular mesangium. Several studies showed that glomerular IgG deposition in IgAN is an important cause of mesangial proliferation and glomerular damage. This study aims to determine the association of the positivity of IgG and the intensity of IgG staining with a poor renal prognosis. Methods: A total of 943 IgAN patients were included in the study. Glomerular IgG staining negative and positive patients were compared using Oxford classification scores, histopathological evaluations, proteinuria, eGFR, albumin, blood pressures. IgG positive patients were classified as (+), (++), (+++) based on their staining intensity, and the association with the prognostic criteria was also evaluated. Results: 81% (n = 764) of the patients were detected as IgG negative, while 19% (n = 179) were positive. Age, gender, body mass index, blood pressure, proteinuria, eGFR, uric acid values were similar in IgG positive and negative patients who underwent biopsy (p > 0.05). Intensity of glomerular IgG positivity was not found to be associated with diastolic and systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p > 0.05 for all, r = − 0.084, r = − 0.102, r = − 0.006, r = 0.062, r = 0.014, r = − 0.044, r = − 0.061, r = − 0.066, r = 0.150, respectively). There was no difference for histopathological findings between IgG (+), IgG (++), IgG (+++) groups (for all, p > 0.05). Conclusion: Glomerular IgG negativity and positivity detected by routine IFM in IgAN patients is not associated with poor renal prognostic risk factors.