Retrospective Cohort Study
Copyright ©The Author(s) 2024.
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 years32 (22-42)
Sex
    Male79 (48.4)
    Female84 (51.5)
Hypertension57 (35)
Serum creatinine in mg/dL2.7 ± 2.9
Estimated glomerular filtration rate in mL/minute/1.73 m253.65 ± 37.7
Serum albumin in g/dL2.3 ± 0.79
Proteinuria by dipstick
    Trace5 (3.1)
    1+17 (10.7)
    2+20 (12.6)
    3+76 (46.6)
    4+45 (27.6)
Microscopic hematuria
    Trace8 (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/dL3.55 ± 3.19
24-hour urinary protein in g/day4.0 ± 2.61
Serum C3 levels
    Low, < 0.8 g/L87 (53.7)
    Normal, > 0.8 g/L76 (46.3)
Serum C4 levels
    Low, < 0.16 g/L40 (24)
    Normal, > 0.16 g/L124 (76)
Required kidney replacement therapy43 (26.4)
Indications for renal biopsy
    Nephrotic27 (16.6)
    Nephritic30 (18.4)
Acute kidney injury106 (65)
Table 2 Histopathological characteristics of patients with primary immunoglobulin associated mesangiocapillary glomerulonephritis
Characteristics
Data
Total glomeruli20.36 ± 10.4
Globally sclerosed2.05 ± 3.5
Presence of crescents57 (35.6)
Mesangial proliferation
    Focal37 (22.6)
    Diffuse126 (77.4)
    Presence of spikes15 (9.4)
    Arteriolosclerosis56 (34.8)
Interstitial fibrosis and tubular atrophy
    None22 (13.49)
    Mild103 (63.1)
    Moderate35 (21.2)
    Severe3 (1.84)
Immunofluorescence results
IgA
    Negative124 (76.1)
    Trace18 (11)
    1+19 (11.7)
    2+2 (2)
    3+0
IgG
    Negative0
    Trace1 (0.6)
    1+17 (10.4)
    2+96 (58.8)
    3+49 (30.06)
IgM
    Negative74 (45.4)
    Trace30 (18.4)
    1+43 (26.4)
    2+11 (6.7)
    3+5 (3.1)
C3
    Negative24 (14.7)
    Trace43 (26.4)
    1+70 (42.9)
    2+17 (10.4)
    3+9 (5.5)
C1q
    Negative91 (55.8)
    Trace17 (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 alone62 (38.0)21 (48.83)41 (34.16)0.08
    CR9 (5.52)2 (4.65)7 (5.83)0.42
    PR36 (22.08)3 (6.97)33 (27.5)< 0.001
    ESKD12 (7.36)12 (27.90)0< 0.001
    Mortality5 (3.06)4 (9.30)1 (0.83)0.04
Cyclophosphamide + steroids21 (12.8)5 (11.62)16 (13.33)0.13
    CR4 (2.45)04 (3.33)0.53
    PR13 (7.97)1 (2.32)12 (10)0.02
    ESKD3 (1.84)3 (6.97)0< 0.001
    Mortality1 (0.61)1 (2.32)00.06
Renal outcomes at 2 years
    CR56 (34.3)3 (6.97)53 (44.1)< 0.001
    PR68 (41.71)5 (11.6)63 (52.5)< 0.001
    ESKD32 (19.63)29 (67.41)3 (2.5)< 0.001
    Mortality7 (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 years32.71 ± 9.8435.71 ± 13.428.44 ± 11.4129.86 ± 13.500.03
Hypertension24 (42.85)21 (30.8)10 (31.25)2 (28.57)0.50
Serum creatinine in mg/dL1.94 ± 1.432.36 ± 2.524.51 ± 4.494.69 ± 4.12< 0.001
Serum albumin in g/dL2.72 ± 0.762.23 ± 0.761.78 ± 0.591.90 ± 0.50< 0.001
protein-to-creatinine ratio in g/dL3.93 ± 0.8793.73 ± 0.5954.22 ± 0.5533.86 ± 3.780.114
Estimated glomerular filtration rate in mL/minute/1.73 m260.33 ± 31.0757.87 ± 41.8338.54 ± 37.1428.20 ± 18.310.01
Required kidney replacement therapy on admission3 (5.35)5 (7.35)29 (90.62)6 (85.71)< 0.001
Serum C3 levels
    Low, < 0.8 g/L27 (48.21)31 (45.5)17 (53.12)4 (57.14)0.84
    Normal, > 0.8 g/L24 (42.85)30 (44.11)11 (34.37)3 (42.85)
Serum C4 levels
    Low, < 0.16 g/L17 (30.35)13 (19.11)4 (12.5)1 (14.28)0.19
    Normal, > 0.16 g/L33 (58.92)49 (72)24 (75)5 (71.42)
Number of globally sclerosed glomeruli0.45 ± 0.801.75 ± 2.425.27 ± 5.643.86 ± 5.36< 0.001
Presence of crescents10 (17.85)25 (36.7)17 (53.12)5 (71.42)< 0.001
Mesangial/endocapillary proliferation
    Focal17 (30.35)15 (22)4 (12.5)00.128
    Diffuse39 (69.64)52 (76.47)28 (87.5)7 (100)
    Presence of spikes012 (17.6)3 (9.37)00.006
Interstitial fibrosis and tubular atrophy
    None16 (28.57)5 (7.35)2 (6.25)0
    Mild37 (66.07)49 (72)14 (43.75)1 (14.28)< 0.001
    Moderate3 (5.35)13 (19.11)13 (40.62)6 (85.71)
    Severe003 (9.37)0