Abstract【Objective】 To investigate the curative effect and predictive value of baseline complement C4 level in the treatment of idiopathic membranous nephropathy (IMN). 【Methods】 A total of 132 patients with IMN who were admitted to our hospital were treated with cyclophosphamide + glucocorticoids. Their clinical and biochemical data were collected at admission. The patients were followed up. According to the treatment effect, patients were divided into the remission group and the non-remission group. The predictive value of baseline complement C4 level on remission rate was analyzed, and the influencing factors of disease remission were analyzed as well. 【Results】 The median follow-up time was 25 months and the average follow-up time was (24.1±3.9) months. A total of 102 patients (77.3%) achieved disease remission and 30 patients did not. ROC curve analysis showed that the baseline complement C4 level predicting area under the curve of IMN disease remission was 0.76 (P=0.005), the sensitivity was 65.2%, and the specificity was 79.8%. Disease remission was associated with C3, C4, urine protein, albumin and pathological stage (P<0.05). Logistic analysis showed that C4, albumin and pathological staging were independent influencing factors of disease remission in IMN patients (P<0.05). On admission, patients with higher C4 level, lower albumin and stageⅢ-Ⅳ IMN had lower disease remission rate after treatment. 【Conclusion】 Baseline complement C4 level has predictive value for IMN treatment effect. IMN patients with elevated C4 on admission have a lower rate of disease remission after treatment and should be given clinical attention.
YANG Ni,YANG Xin-bo,GAO Xin, et al. Effect of Complement C4 Level on Treatment of Idiopathic Membranous Nephropathy[J]. JOURNAL OF CLINICAL RESEARCH, 2021, 38(5): 717-719.
[1] SALANT DJ. Unmet challenges in membranous nephropathy[J].Curr Opin Nephrol Hypertens,2019,28(1):70-76. [2] WEHLING C, AMON O, BOMMER M, et al. Monitoring of complement activation biomarkers and eculizumab in complement-mediated renal disorders[J].Clin Exp Immunol,2017,187(2):304-315. [3] LAI WL, YEH TH, CHEN PM, et al. Membranous nephropathy: a review on the pathogenesis, diagnosis, and treatment[J].J Formos Med Assoc,2015,114(2):102-111. [4] PAN X, XU J, REN H, et al. Changing spectrum of biopsy-proven primary glomerular diseases over the past 15 years: a single-center study in China[J].Contrib Nephrol,2013,181:22-30. [5] ZHANG M F, CUI Z, ZHANG Y M, et al. Clinical and prognostic significance of glomerular C1q deposits in primary MN[J].Clin Chim Acta,2018,485:152-157. [6] SINICO R A, MEZZINA N, TREZZI B, et al.Immunology of membranous nephropathy: from animal models to humans[J].Clin Exp Immunol,2016 ,183(2):157-165. [7] CUSTÓDIO F B, SILVA C A D, HELMO F R, et al.Complement System and C4d expression in cases of Membranous nephropathy[J].J Bras Nefrol,2017,39(4):370-375. [8] 贺红光,黄亿芸,曾春, 等.环磷酰胺联合糖皮质激素治疗特发性膜性肾病疗效的影响因素分析[J].中华肾脏病杂志,2019,35(1):9-17. [9] MA H, SANDOR D G, BECK L J. The role of complement in membranous nephropathy[J].Semin Nephrol,2013,33(6):531-542. [10] VAL-BERNAL J F, GARIJO M F, VAL D, et al. C4d immunohistochemical staining is a sensitive method to confirm immunoreactant deposition in formalin-fixed paraffin-embedded tissue in membranous glomerulonephritis[J].Histol Histopathol,2011,26(11):1391-1397. [11] ESPINOSA M, ORTEGA R, SANCHEZ M, et al. Association of C4d deposition with clinical outcomes in IgA nephropathy[J].Clin J Am Soc Nephrol,2014,9(5):897-904.
2021, Vol. 38 
