ABSTRACT
Mesangial C4d deposits have been associated with worse outcomes in Western patients with IgA nephropathy (IgAN), but there is limited data in Asians. Previously, a high proportion of stained glomeruli was often required for the classification of C4d positive (C4d+ve). Positive staining in lower proportion of staining would be classified as C4d-ve. This retrospective study evaluated the prognostic value of C4d+ve using a less stringent definition (one C4d+ve glomerulus) in Thai patients with IgAN (n = 120). Baseline findings and outcomes were compared between those with more extensive C4d staining patterns and those with more restricted staining. Clinico-pathologic parameters and risk for kidney outcomes (kidney failure or decline GFR50%) were compared between C4d+ve versus C4d-ve, and between different patterns: Focal (< 50%) versus Diffuse (≥ 50% of glomeruli); or Global (≥ 50) versus Segmental (< 50% of mesangial area). The hazard ratios were estimated using Cox proportional hazard models for Model 1 (Oxford score+ C4d) and Model 2 (Model 1+ clinical factors). C4d+ve (n = 81) had lower eGFR, more global sclerosis, and interstitial fibrosis than C4d-ve at baseline. The 5-year kidney survival for C4d+ve was lower (53.7%) than C4d-ve (89.7%); P = 0.0255. By univariate analysis, T1, T2, C4d+ve, eGFR<60, proteinuria were predictors of kidney outcome. By multivariate analysis, proteinuria, T1, T2 and C4d+ve were independent predictors (Model 2 HR (95% CI) C4d+ve: 3.24 (1.09-9.58), p = 0.034). Segmental had lower eGFR, higher tubulointerstitial fibrosis, and segmental sclerosis compared to Global pattern. Clinicopathological parameters were not different between Focal and Diffuse patterns. Outcomes were similar between staining patterns. In conclusion, C4d staining may be a valuable marker of poor prognosis in Asian patients with IgAN. Less stringent criteria for C4d+ve should be considered as no differences in outcomes were observed between more extensive staining with less extensive patterns. More studies are needed to identify the optimum criteria for C4d+ve.
Subject(s)
Complement C4b/metabolism , Glomerular Mesangium/metabolism , Glomerulonephritis, IGA/diagnosis , Renal Insufficiency/diagnosis , Adult , Female , Glomerular Filtration Rate , Glomerular Mesangium/pathology , Glomerulonephritis, IGA/complications , Glomerulonephritis, IGA/pathology , Humans , Male , Middle Aged , Prognosis , Proportional Hazards Models , Proteinuria/complications , Renal Insufficiency/etiology , Retrospective Studies , Risk Factors , Severity of Illness Index , Thailand , Young AdultABSTRACT
OBJECTIVE: Analyze if bladder mucosa of patients with bladder pain syndrome (BPS) have more estrogen receptor (ER) and progesterone receptor (PR) than the normal population. MATERIAL AND METHOD: Between July 2009 and December 2010, 15 female patients with chronic bladder pain syndrome and 10 female patients without bladder pain were enrolled in the present study. Three pieces of trigonal bladder mucosa were biopsied and sent for estrogen receptor and progesterone receptor immunohistochemistry staining by the Benchmark automated machine. The results were reported as positive and negative and then compared between the two groups. RESULTS: Estrogen receptor was found in 14 out of 15 patients in the BPS group (93%) and in 7 out of 10 patients in the control group (70%). Progesterone receptor was found in 10 out of 15 patients in the BPS group (66.7%) and 5 out of 10 patients in the control group. Both were not significantly different with p = 0.267 and p = 0.678, respectively. CONCLUSION: The authors concluded that ER and PR might not play a role in the etiopathogenesis of BPS/IC. However other receptors should be further investigated about their role in this type of pain.
