ArticleModern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc2019
Complement-mediated microangiopathy in IgA nephropathy and IgA vasculitis with nephritis.
Article in Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 1 of them a synthesis that pooled it.
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41 citing papers in PubMed, 1 synthesis or guideline pooled it, 62 citations in OpenAlex.
- Prognostic value of vascular lesions in immunoglobulin a nephropathy: a meta-analysis.BMC nephrology · 2026Pooled it
- Low-density granulocyte-driven NET formation is associated with poor prognosis in IgA nephropathy with thrombotic microangiopathy.Renal failure · 2026Article
- Infectious triggers in IgA vasculitis in children: current evidence, causal attribution and immunopathogenic mechanisms.Rheumatology international · 2026Review
- IgA nephropathy: an overview of the disease, its pathophysiology, and involvement of the gut-kidney axis.Kidney international supplements · 2026Review
- FSTIV score is essential for clinical management and predicts outcome of idiopathic membranous nephropathy.BMC nephrology · 2026Article
- Complement-Mediated Kidney Diseases: Role of Alternative Pathway in Glomerular Inflammation.Kidney international reports · 2026Review
- Immunoglobulin A Nephropathy With Associated Thrombotic Microangiopathy: Biopsy and Clinical Case Series.Clinical medicine insights. Case reports · 2026Article
- Complement biomarkers in IgA nephropathy: current insights and clinical relevance.Frontiers in nephrology · 2026Review
- The Proportion of New-Onset Microangiopathic Lesions in IgA Nephropathy is Increased After COVID-19 Pandemic in China.Kidney medicine · 2025Article
- Modern biomarkers in IgA vasculitis with nephritis in children.Central-European journal of immunology · 2025Review
- Novel Biomarkers as Non-Invasive Diagnostic Tools in IgA Nephropathy: A Comparative Study with Lupus Nephritis and Membranous Nephropathy.Journal of inflammation research · 2025Article
- IgA Vasculitis (Henoch-Schönlein Purpura): An Update on Treatment.Journal of clinical medicine · 2024Review
- Clinicopathological features and prognosis of IgA vasculitis nephritis with nephrotic-range proteinuria in children.Pediatric nephrology (Berlin, Germany) · 2024Article
- C4d Is an Independent Predictor of the Kidney Failure in Primary IgA Nephropathy.Journal of clinical medicine · 2024Article
- Navigating Adult-Onset IgA Vasculitis-Associated Nephritis.Life (Basel, Switzerland) · 2024Review
- C3 Hypocomplementemia Predicts the Progression of CKD towards End-Stage Kidney Disease in IgA Nephropathy, Irrespective of Histological Evidence of Thrombotic Microangiopathy.Journal of clinical medicine · 2024Article
- Unravelling the Link between the Gut Microbiome and Autoimmune Kidney Diseases: A Potential New Therapeutic Approach.International journal of molecular sciences · 2024Review
- Systematic Review of the Link Between Oxford MEST-C Classification and Complement Activation in IgA Nephropathy.Kidney international reports · 2024Article
- Microangiopathy associated with poor outcome of immunoglobulin A nephropathy: a cohort study and meta-analysis.Clinical kidney journal · 2024Article
- Heterozygous mutations in factor H aggravate pathological damage in a stable IgA deposition model induced byFrontiers in immunology · 2024Article
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8 authors at 1 institution in 1 country.
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Abstract
Complement factor C4d was recently observed in renal biopsies from patients who had IgA nephropathy and a poor prognosis. We previously reported that C4d is a common denominator in microangiopathies. In this retrospective cohort study, we investigated whether C4d is a marker of microangiopathy in both IgA nephropathy and IgA vasculitis with nephritis, and whether patients with C4d and microangiopathy have poor renal outcome. We examined 128 renal biopsies from adult and pediatric patients, including normotensive and hypertensive patients, who presented with IgA nephropathy or IgA vasculitis with nephritis. Biopsies were re-evaluated in accordance with the Oxford classification, scored for additional lesions, and stained for complement proteins using immunohistochemistry, including C4d and C5b-9. Clinical data were collected with a mean (±SD) follow-up period of 51 ± 39 months. Changes in estimated glomerular filtration rate over time were compared using linear mixed-effects models. Renal survival was analyzed using multivariable Cox regression. Microangiopathic lesions were present in 20% of all biopsies (23% and 9% of patients with IgA nephropathy and IgA vasculitis with nephritis, respectively). Microangiopathy was associated with C4d and C5b-9 deposits, a higher number of chronic lesions, and hypertension (all p < 0.05). Patients with C4d and microangiopathic lesions had significantly poorer renal survival than patients without these findings, corrected for hypertension (p < 0.01). In conclusion, patients with IgA nephropathy or IgA vasculitis with nephritis with a combination of C4d positivity and microangiopathy comprise a clinical subgroup with an increased number of chronic lesions, lower estimated glomerular filtration rate, and poorer renal survival, even when corrected for hypertension. These data suggest that complement activation is involved in the development of microangiopathy in patients with IgA nephropathy and IgA vasculitis with nephritis, and that complement-mediated microangiopathy contributes to disease progression.
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