title: Clinical implications of linear immunofluorescent staining for immunoglobulin G in patients with diabetic nephropathy.
abstract: OBJECTIVE
  The kidneys of patients with diabetes mellitus usually exhibit a characteristic pattern of linear immunofluorescent staining for immunoglobulin G (IgG) along the glomerular and tubular basement membranes. However, the association between linear IgG staining and the renal prognosis remains unclear.
  
  
  METHODS
  Among 223 patients with diabetes who underwent renal biopsy from 1985 to 2010 and were confirmed to have pure diabetic nephropathy according to the classification of Tervaert et al., 165 patients (glomerular classes I to III) were enrolled in this study. Immunofluorescent staining was classified into three categories according to its intensity (0=none, 1=weakly positive, and 2=positive). Cox proportional hazards regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for death-censored renal death, with each regression analysis employing four levels of multivariate adjustment.
  
  
  RESULTS
  After adjustment for important clinical factors at the time of renal biopsy, the HR for death-censored renal death in patients with an IgG staining score of 1 or 2 was, respectively, 3.01 (95% CI: 1.05-8.68) and 4.68 (1.67-13.1) compared with patients who had a staining score of 0. Even after adjustment for clinical variables and pathological findings, the HR for IgG score of 1 or 2 was higher than that for an IgG score of 0, and it was, respectively, 2.22 (0.71-7.00) and 3.76 (1.27-11.2).
  
  
  CONCLUSIONS
  More intense linear IgG staining is associated with a higher HR for renal death, which suggests that linear immunofluorescent staining for IgG may be a prognostic indicator in patients with diabetic nephropathy.
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan. Electronic address: kokims-frz@umin.ac.jp.
authors.forename: Koki
authors.initials: K
authors.lastname: Mise
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ueno
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Eiko
authors.initials: E
authors.lastname: Hasegawa
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.affiliation: Department of Pathology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Shigeko
authors.initials: S
authors.lastname: Hara
authors.affiliation: Department of Pathology, Toranomon Hospital, Tokyo, Japan; Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ohashi
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003928:Diabetic Nephropathies / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis* / Q000276:immunology; D007678:Kidney Glomerulus / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013194:Staining and Labeling / Q000379:methods; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G
keywords: Diabetic nephropathy; Linear immunofluorescent IgG staining; Pathology; Renal biopsy; Renal prognosis