Elahi T, Ahmed S, Mubarak M. Short-term renal and patient outcomes of primary immunoglobulin-associated mesangiocapillary glomerulonephritis: Insights from a developing country. World J Nephrol 2024; 13(4): 98969 [DOI: 10.5527/wjn.v13.i4.98969]
Corresponding Author of This Article
Muhammed Mubarak, MD, Full Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Pakistan. drmubaraksiut@yahoo.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Retrospective Cohort Study
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World J Nephrol. Dec 25, 2024; 13(4): 98969 Published online Dec 25, 2024. doi: 10.5527/wjn.v13.i4.98969
Table 1 Clinical and laboratory characteristics at the time of presentation of patients with primary immunoglobulin associated mesangiocapillary glomerulonephritis
Characteristics
Data among total, n = 163
Age at biopsy in years
32 (22-42)
Sex
Male
79 (48.4)
Female
84 (51.5)
Hypertension
57 (35)
Serum creatinine in mg/dL
2.7 ± 2.9
Estimated glomerular filtration rate in mL/minute/1.73 m2
53.65 ± 37.7
Serum albumin in g/dL
2.3 ± 0.79
Proteinuria by dipstick
Trace
5 (3.1)
1+
17 (10.7)
2+
20 (12.6)
3+
76 (46.6)
4+
45 (27.6)
Microscopic hematuria
Trace
8 (4.9)
1+
17 (10.4)
2+
18 (11.04)
3+
77 (47.2)
4+
43 (26.3)
Spot protein-to-creatinine ratio in mg/dL
3.55 ± 3.19
24-hour urinary protein in g/day
4.0 ± 2.61
Serum C3 levels
Low, < 0.8 g/L
87 (53.7)
Normal, > 0.8 g/L
76 (46.3)
Serum C4 levels
Low, < 0.16 g/L
40 (24)
Normal, > 0.16 g/L
124 (76)
Required kidney replacement therapy
43 (26.4)
Indications for renal biopsy
Nephrotic
27 (16.6)
Nephritic
30 (18.4)
Acute kidney injury
106 (65)
Table 2 Histopathological characteristics of patients with primary immunoglobulin associated mesangiocapillary glomerulonephritis
Characteristics
Data
Total glomeruli
20.36 ± 10.4
Globally sclerosed
2.05 ± 3.5
Presence of crescents
57 (35.6)
Mesangial proliferation
Focal
37 (22.6)
Diffuse
126 (77.4)
Presence of spikes
15 (9.4)
Arteriolosclerosis
56 (34.8)
Interstitial fibrosis and tubular atrophy
None
22 (13.49)
Mild
103 (63.1)
Moderate
35 (21.2)
Severe
3 (1.84)
Immunofluorescence results
IgA
Negative
124 (76.1)
Trace
18 (11)
1+
19 (11.7)
2+
2 (2)
3+
0
IgG
Negative
0
Trace
1 (0.6)
1+
17 (10.4)
2+
96 (58.8)
3+
49 (30.06)
IgM
Negative
74 (45.4)
Trace
30 (18.4)
1+
43 (26.4)
2+
11 (6.7)
3+
5 (3.1)
C3
Negative
24 (14.7)
Trace
43 (26.4)
1+
70 (42.9)
2+
17 (10.4)
3+
9 (5.5)
C1q
Negative
91 (55.8)
Trace
17 (10.4)
1+
28 (17.1)
2+
23 (14.1)
3+
4 (2.45)
Table 3 Treatment and renal outcomes in patients with and without the requirement of kidney replacement therapy on presentation over 2 years
Parameters
Overall, n = 163
KRT required on presentation, n = 43
KRT not required on presentation, n = 120
P value
Steroids alone
62 (38.0)
21 (48.83)
41 (34.16)
0.08
CR
9 (5.52)
2 (4.65)
7 (5.83)
0.42
PR
36 (22.08)
3 (6.97)
33 (27.5)
< 0.001
ESKD
12 (7.36)
12 (27.90)
0
< 0.001
Mortality
5 (3.06)
4 (9.30)
1 (0.83)
0.04
Cyclophosphamide + steroids
21 (12.8)
5 (11.62)
16 (13.33)
0.13
CR
4 (2.45)
0
4 (3.33)
0.53
PR
13 (7.97)
1 (2.32)
12 (10)
0.02
ESKD
3 (1.84)
3 (6.97)
0
< 0.001
Mortality
1 (0.61)
1 (2.32)
0
0.06
Renal outcomes at 2 years
CR
56 (34.3)
3 (6.97)
53 (44.1)
< 0.001
PR
68 (41.71)
5 (11.6)
63 (52.5)
< 0.001
ESKD
32 (19.63)
29 (67.41)
3 (2.5)
< 0.001
Mortality
7 (4.29)
6 (13.9)
1 (0.83)
0.001
Table 4 Comparison between renal outcomes and baseline clinicopathological parameters in patients with primary immunoglobulin-associated mesangiocapillary glomerulonephritis
Variables
Complete remission, n = 56
Partial remission, n = 68
End-stage kidney disease, n = 32
Mortality, n = 7
P value
Age in years
32.71 ± 9.84
35.71 ± 13.4
28.44 ± 11.41
29.86 ± 13.50
0.03
Hypertension
24 (42.85)
21 (30.8)
10 (31.25)
2 (28.57)
0.50
Serum creatinine in mg/dL
1.94 ± 1.43
2.36 ± 2.52
4.51 ± 4.49
4.69 ± 4.12
< 0.001
Serum albumin in g/dL
2.72 ± 0.76
2.23 ± 0.76
1.78 ± 0.59
1.90 ± 0.50
< 0.001
protein-to-creatinine ratio in g/dL
3.93 ± 0.879
3.73 ± 0.595
4.22 ± 0.553
3.86 ± 3.78
0.114
Estimated glomerular filtration rate in mL/minute/1.73 m2
60.33 ± 31.07
57.87 ± 41.83
38.54 ± 37.14
28.20 ± 18.31
0.01
Required kidney replacement therapy on admission
3 (5.35)
5 (7.35)
29 (90.62)
6 (85.71)
< 0.001
Serum C3 levels
Low, < 0.8 g/L
27 (48.21)
31 (45.5)
17 (53.12)
4 (57.14)
0.84
Normal, > 0.8 g/L
24 (42.85)
30 (44.11)
11 (34.37)
3 (42.85)
Serum C4 levels
Low, < 0.16 g/L
17 (30.35)
13 (19.11)
4 (12.5)
1 (14.28)
0.19
Normal, > 0.16 g/L
33 (58.92)
49 (72)
24 (75)
5 (71.42)
Number of globally sclerosed glomeruli
0.45 ± 0.80
1.75 ± 2.42
5.27 ± 5.64
3.86 ± 5.36
< 0.001
Presence of crescents
10 (17.85)
25 (36.7)
17 (53.12)
5 (71.42)
< 0.001
Mesangial/endocapillary proliferation
Focal
17 (30.35)
15 (22)
4 (12.5)
0
0.128
Diffuse
39 (69.64)
52 (76.47)
28 (87.5)
7 (100)
Presence of spikes
0
12 (17.6)
3 (9.37)
0
0.006
Interstitial fibrosis and tubular atrophy
None
16 (28.57)
5 (7.35)
2 (6.25)
0
Mild
37 (66.07)
49 (72)
14 (43.75)
1 (14.28)
< 0.001
Moderate
3 (5.35)
13 (19.11)
13 (40.62)
6 (85.71)
Severe
0
0
3 (9.37)
0
Citation: Elahi T, Ahmed S, Mubarak M. Short-term renal and patient outcomes of primary immunoglobulin-associated mesangiocapillary glomerulonephritis: Insights from a developing country. World J Nephrol 2024; 13(4): 98969