Gogulapati, Anusha

Jen, Kuang-Yu

Shaikh, Sana

English

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UC DavisNephrologyTitleClinical Significance of Complement Depositionin Recurrent IgA Nephropathy after Kidney TransplantationPermalinkhttps://escholarship.org/uc/item/8s24n12sAuthorsGogulapati, AnushaJen, Kuang-YuShaikh, SanaPublication Date2025-04-01Data AvailabilityThe data associated with this publication are not available for this reason: NAeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaClinical Significance of Complement Deposition in Recurrent IgA Nephropathy after Kidney TransplantationAnusha Gogulapati, BSKuang-Yu Jen, MD, PhDSana Shaikh, MDIntroductionKidney transplant patients from our center with biopsy-proven recurrent IgAN were retrospectively included (2016-2023). The index post-transplant biopsy confirming diagnosis was used for analysis. Patients were grouped as IgA with or without C3 using a ≥2+ immunofluorescence intensity threshold for C3. Renal function was assessed at index biopsy and serially for 3 years. Primary outcomes were:• Clinical recurrence: proteinuria ≥1 g/day, microscopic hematuria, ≥40% glomerular filtration rate (GFR) decline, or MEST-C scores of M1, E1, or C1 and • Renal composite endpoint: ≥40% GFR decline, GFR <15 mL/min/1.73 m² or dialysis dependenceSecondary outcomes were:• GFR at 6 months, 1 year, 2 years, and 3 years• Proteinuria at 6 months, 1 year, 2 years, and 3 yearsResults64 patients had recurrent IgAN with 24 showing concurrent C3 staining. Baseline characteristics such as age, sex, ethnicity, cause of renal disease, type of transplant and  immunosuppression were similar between groups. Histologic: The IgA+C3 group had significantly stronger IgA staining and increased mesangial hypercellularity. Clinical: The IgA+C3 group had significantly higher proteinuria. Primary Outcome: The primary outcome of clinical recurrence was more frequent in the IgA+C3 group, but the difference was not statistically significant. Secondary Outcome: There was no difference in GFR in both groups at any of the follow up time points. Proteinuria was comparable at 6 months and 1 year but significantly higher in the IgA+C3 group at 2 years. By 3 years, more patients in the IgA+C3 group had nephrotic range proteinuria but this difference was not significant.In recurrent IgAN, C3 deposition is associated with significantly higher proteinuria at the time of diagnosis and 2 years, with a trend towards more nephrotic-range proteinuria at 3 years. This suggests that C3 deposition can drive more aggressive disease, highlighting the need for further studies.  References: (1) Uffing A, Pérez-Saéz MJ, Jouve T, et al. Recurrence of IgA Nephropathy after Kidney Transplantation in Adults. Clin J Am Soc Nephrol. 2021;16(8):1247-1255. (2) Knoppova B, Reily C, King RG, et al. Pathogenesis of IgA Nephropathy: Current Understanding and Implications for Development of Disease-Specific Treatment. J Clin Med. 2021;10(19):4501. Acknowledgement: We would like to thank Sili Fan, our statistician, for his assistance in the data analysis of this study. Index Biopsy, p=0.005                         Six Month, p=0.361                            One Year, p=0.712 Two Year, p=0.010                            Three Year, p=0.156IgA without C3         IgA with C3                IgA without C3        IgA with C3Proteinuria Classification<0.50.5-0.9Sub Nephrotic Range – 1-3.4Nephrotic Range – includes ≥ 3.5DesignBiopsies of patients with IgA nephropathy (IgAN) often reveal mesangial complement deposition indicating activation of complement pathways. Existing literature shows that complement (C) 3 deposition can prognosticate IgAN in native kidneys. This study investigates the clinical implications of C3 deposition in recurrent IgAN after kidney transplantation.Summary

Clinical Significance of Complement Depositionin Recurrent IgA Nephropathy after Kidney Transplantation

https://escholarship.org/content/qt8s24n12s/qt8s24n12s.pdf

Clinical Significance of Complement Depositionin Recurrent IgA Nephropathy after Kidney Transplantation

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