The Spectrum of C4d Deposition in Renal Biopsies of Lupus Nephritis Patients

Frontiers in Immunology

Ying Ding¹  Lihua Wu²  Xiaojuan Yu³  Feng Yu³  Ying Tan⁴  Zhen Qu⁵ 

[1] Institute of Nephrology, Peking University;Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China;Key Laboratory of Renal Disease, Ministry of Health of China;Department of Nephrology, Peking University International Hospital, Beijing, China;Renal Division, Department of Medicine, Peking University First Hospital;

关键词: C4d;    lupus nephritis;    renal microvascular lesions;    complement;    prognosis;   

DOI  :  10.3389/fimmu.2021.654652

来源: DOAJ

【 摘 要 】

ObjectivesThis study aimed to determine the prevalence and localization of complement factor C4d in renal biopsies from patients with lupus nephritis (LN), as well as its associations with the disease’s clinico-pathological features. The correlation between arteriolar C4d deposition and renal microvascular lesions (RVLs) was further analyzed.MethodsA total of 325 biopsy-proven LN patients were enrolled, and their clinico-pathological data were collected. C4d staining of renal biopsies was performed by immunohistochemistry. The associations between C4d deposition and the clinico-pathological features were further analyzed.ResultsC4d deposition was present in most (98.8%) renal specimens in our cohort. These deposits were localized in the glomeruli (98.2%), tubular basement membrane (TBM) (43.7%), arterioles (31.4%), and peritubular capillary (33.8%). Patients with TBM C4d staining had higher disease activity (measured with the Systemic Lupus Erythematous Disease Activity Index) and higher National Institutes of Health pathological activity and chronicity indices (all P < 0.01). Patients with arteriolar C4d deposition were more likely to develop RVLs (91.2%) compared to those with no arteriolar C4d deposition (78.0%; P = 0.004), especially with two or more types of RVLs (P < 0.001). During the mean follow-up of 55.8 months, arteriolar C4d was related to worse renal outcomes [hazard ration (HR): 2.074, 95% confidence interval (CI) 1.056–4.075, P = 0.034]. Multivariate Cox hazard analysis showed that co-deposition of arteriolar C4d and C3c was an independent risk factor (HR: 3.681, 95% CI 1.519–8.921, P = 0.004) for predicting renal outcomes.ConclusionsC4d deposition was common in renal tissues from LN patients. TBM C4d deposition was related to the disease activity, and arteriolar C4d deposition was associated with RVLs and worse renal outcomes.

【 授权许可】

Unknown