Tubular decoy receptor 2 as a predictor of prognosis in patients with immunoglobulin A nephropathy
| Autor: | Huanzi Dai, Jia Chen, Liming Wang, Yani He, Lirong Lin, Wei Hu |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
senescence Tubular atrophy 030232 urology & nephrology Urology Renal function predictor Mesangial hypercellularity urologic and male genital diseases 03 medical and health sciences 0302 clinical medicine Biopsy Medicine renal outcome AcademicSubjects/MED00340 030304 developmental biology 0303 health sciences Transplantation Kidney Proteinuria medicine.diagnostic_test business.industry Proportional hazards model Original Articles IgA nephropathy medicine.anatomical_structure Nephrology DcR2 Renal biopsy medicine.symptom business |
| Zdroj: | Clinical Kidney Journal |
| ISSN: | 2048-8513 |
| DOI: | 10.1093/ckj/sfaa257 |
| Popis: | Background Accelerated senescence of renal tubular epithelial cells (RTECs) might contribute to immunoglobulin A nephropathy (IgAN) progression. This study aimed to determine whether the RTEC senescence marker, decoy receptor 2 (DcR2), could predict prognosis in IgAN. Methods We included a retrospective cohort of 105 patients with biopsy-proven IgAN. Tubular DcR2 expression was assessed at renal biopsy and the Oxford histological MEST-C score [mesangial hypercellularity (M), endocapillary proliferation (E), segmental sclerosis (S), interstitial fibrosis/tubular atrophy (T) and crescents (C)] defined disease severity. IgAN progression was defined as a composite of end-stage renal disease or a 30% decline in the estimated glomerular filtration rate (eGFR), analyzed using Kaplan–Meier and Cox regression analyses. Results Tubular DcR2 was overexpressed in IgAN. Numbers of DcR2 and p16 double-positive RTECs increased with increasing severity of tubular atrophy/interstitial fibrosis (T lesion). Patients with ≥25% tubular DcR2 expression experienced worse proteinuria, T lesions and a lower eGFR. Cumulative renal survival was significantly lower in patients with ≥25% DcR2 positivity. Multivariate regression analyses showed that ≥25% tubular DcR2 expression was significantly associated with worse eGFR slopes (the rate of renal function decline; P = 0.003) and the incidence of the composite outcome (P = 0.001) in IgAN. The addition of tubular DcR2 to a model with clinical data at biopsy (mean arterial pressure, proteinuria and eGFR) or MEST-C score significantly improved the 5-year risk prediction of IgAN progression, as confirmed by receiver operating characteristic curve analyses. Conclusions Tubular DcR2 expression detected at biopsy was a strong independent predictor for IgAN progression and might have prognostic value in addition to established risk markers. |
| Databáze: | OpenAIRE |
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