Oxidative stress and macrophage infiltration in IgA nephropathy

• Published in: Journal of nephrology 2022-05, Vol.35 (4), p.1101-1111
• Main Authors: Caliskan, Yasar, Demir, Erol, Karatay, Ecem, Ozluk, Yasemin, Mirioglu, Safak, Dirim, Ahmet Burak, Artan, Ayse Serra, Usta Akgul, Sebahat, Oto, Ozgur Akin, Savran Oguz, Fatma, Turkmen, Aydin, Lentine, Krista L., Yazici, Halil
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Advanced Oxidation Protein Products; Aged; Female; Galactose; Glomerulonephritis, IGA - pathology; Humans; Immunoglobulin A; Macrophages; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Original Article; Oxidative Stress; Urology; Young Adult
• ISSN: 1724-6059; 1724-6059
• DOI: 10.1007/s40620-021-01196-7

Background The aim of this study was to evaluate the interactions among serum levels of galactose-deficient IgA1 (Gd-IgA1), oxidative stress and macrophage infiltration and their clinical correlates in patients with IgA Nephropathy (IgAN). Methods A total of 47 patients with biopsy-proven primary IgAN, aged between 16 and 79 years, with a follow-up period ≥ 1 year or who showed progression to end stage kidney disease (ESKD) regardless the duration of follow-up were included. Study endpoint was the progression to ESKD. Serum Gd-IgA1 and advanced oxidation protein product (AOPP) levels were measured using ELISA assays. Kidney biopsies were evaluated according to the Oxford MEST-C scoring, with C4d and CD68 staining. Results Seventeen patients (36%) experienced ESKD during a median follow-up time of 6 years (IQR 3.7–7.5). Serum AOPP levels were correlated with the intensity of glomerular C3 deposition (r = 0.325, p = 0.026), glomerular (r = 0.423, p = 0.003) and interstitial CD68 + cell count (r = 0.298, p = 0.042) and Gd-IgA1 levels (r = 0.289, p = 0.049). Serum Gd-IgA1 levels were correlated with the intensity of C3 deposition (r = 0.447, p = 0.002). eGFR at biopsy (adjusted HR (aHR) 0.979 p = 0.011), and E score (aHR, 8.305, p = 0.001) were associated with progression to ESKD in multivariate analysis. 5-year ESKD-free survival rate was significantly lower in patients with higher E score compared to patients with E score 0 [p = 0.021]. Conclusions An increased number of macrophages in the glomerular and tubulointerstitial area may play a role in oxidative stress and complement system activation. Endocapillary hypercellularity is a predictive factor for poor prognosis in IgAN. Graphical abstract