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Clinical relevance of membrane attack complex deposition in children with IgA nephropathy and Henoch-Schönlein purpura

  • Camille Dumont
  • Aicha Mérouani
  • Thierry Ducruet
  • Geneviève Benoit
  • Marie-Josée Clermont
  • Anne Laure Lapeyraque
  • Véronique Phan
  • Natalie PateyEmail author
Original Article

Abstract

Background

IgA nephropathy (IgAN) and Henoch-Schönlein purpura are common glomerular disorders in children sharing the same histopathologic pattern of IgA deposits within the mesangium, even if their physiopathology may be different. Repeated exposure to pathogens induces the production of abnormal IgA1. The immune complex deposition in the renal mesangium in IgAN or potentially in small vessels in Henoch-Schönlein purpura induces complement activation via the alternative and lectin pathways. Recent studies suggest that levels of membrane attack complex (MAC) in the urine might be a useful indicator of renal injury. Because of the emerging availability of therapies that selectively block complement activation, the aim of the present study is to investigate whether MAC immunostaining might be a useful marker of IgA-mediated renal injury.

Methods

We conducted immunohistochemistry analysis of the MAC on renal biopsies from 67 pediatric patients with IgAN and Henoch-Schönlein purpura. We classified their renal biopsies according to the Oxford classification, retrieved symptoms, biological parameters, treatment, and follow-up.

Results

We found MAC expression was significantly related to impaired renal function and patients whose clinical course required therapy. MAC deposits tend to be more abundant in patients with decreased glomerular filtration rate (p = 0.02), patients with proteinuria > 0.750 g/day/1.73 m2, and with nephrotic syndrome. No correlation with histological alterations was observed.

Conclusions

We conclude that MAC deposition could be a useful additional indicator of renal injury in patients with IgAN and Henoch-Schönlein purpura, independent of other indicators.

Keywords

Membrane attack complex IgA nephropathy Henoch-Schönlein purpura Pediatric 

Notes

Acknowledgments

The authors thank Dr. Luc Laurier Oligny for his constructive criticisms.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© IPNA 2020

Authors and Affiliations

  1. 1.Department of PathologyCHU Sainte JustineMontréalCanada
  2. 2.Department of NephrologyCHU Sainte-Justine, Université de MontréalMontréalCanada
  3. 3.Applied Clinical Research UnitCHU Sainte-Justine, Université de MontréalMontréalCanada

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