title: Glomerular mannose-binding lectin deposition is a useful prognostic predictor in immunoglobulin A nephropathy.
abstract: There is accumulating evidence to support a hypothesis of the activation of the lectin complement pathway in immunoglobulin A nephropathy (IgAN). The glomerular deposition of mannose-binding lectin (MBL), an initiator of the lectin pathway, has been identified, but its clinical significance has not been defined consistently. The aim of the present study was to investigate the value of glomerular MBL deposition as a useful histological biomarker in evaluating the severity and predicting the prognosis of IgAN. We included all consecutive patients with biopsy-proven primary IgAN from December 2008 to July 2010. Renal deposition of MBL was detected by immunofluorescence. The biopsy material from 131 patients (72 men) was thus used for MBL staining. The deposition of MBL was observed in a predominantly mesangial pattern in 45 patients (34·35%), which presented as global or segmental deposition. Compared with the patients without glomerular MBL deposition, those with glomerular MBL deposition had more severe proteinuria, decreased renal function, lower levels of serum albumin and a greater possibility of hypertension at the time of renal biopsy; they had more severe histological changes according to the Oxford classification (i.e. mesangial hypercellularity, segmental glomerulosclerosis, endocapillary hypercellularity and tubular atrophy/interstitial fibrosis), and their ratio presented an increase as the histopathological phenotypes segregated according to Lee's classification; furthermore, the follow-up data demonstrated that they had a lower renal remission rate. In conclusion, glomerular MBL deposition may predict a poor prognosis, and thus can be a new prognostic factor in IgA nephropathy.
authors.affiliation: Department of Nephrology, The First Hospital of China Medical University, Shen Yang, China.
authors.forename: L-L
authors.initials: LL
authors.lastname: Liu
authors.forename: N
authors.initials: N
authors.lastname: Liu
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.forename: L-N
authors.initials: LN
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Jiang
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: X-L
authors.initials: XL
authors.lastname: Li
authors.forename: L
authors.initials: L
authors.lastname: Yao
authors.forename: Q-L
authors.initials: QL
authors.lastname: Fan
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000276:immunology* / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007678:Kidney Glomerulus / Q000276:immunology* / Q000378:metabolism*; D008297:Male; D037601:Mannose-Binding Lectin / Q000378:metabolism*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012074:Remission Induction; D055815:Young Adult
chemical_list: D015415:Biomarkers; D037601:Mannose-Binding Lectin
keywords: IgA nephropathy; MBL; biomarker; complement; prognosis