Introduction:
Background:Lupus Nephritis (LN) is a severe manifestation of Systemic Lupus Erythematosus (SLE) that significantly contributes to morbidity and mortality. The deposition of Complement component 4d (C4d), a product of complement system activation, has been implicated in the pathogenesis and prognosis of LN. While C4d is well-recognized as a marker in antibody-mediated rejection in renal transplantation, its role in native glomerular diseases, particularly LN, requires further elucidation.
Objective:This study aims to evaluate the incidence, distribution, and clinical significance of C4d deposition in renal biopsies of patients with Lupus Nephritis. Additionally, the study seeks to correlate C4d deposition with histopathological findings, laboratory parameters, and the severity of renal involvement, providing insights into its prognostic value in LN.
Methods:
A retrospective cross-sectional analysis was conducted on 350 patients diagnosed with Lupus Nephritis who underwent renal biopsy at AL-SAEGH Center of Nephrology and Kidney Transplantation between January 2020, and September 2023. Immunohistochemical staining was utilized to assess C4d deposition in renal tissues. The study correlated C4d positivity with LN classes, levels of anti-double stranded DNA (anti-dsDNA) antibodies, complement components (C3, C4), and proteinuria. Statistical analyses were performed to determine the significance of these associations.
Results:
C4d deposition was observed in 40% of the LN cases. C4d positivity was significantly associated with higher levels of anti-dsDNA antibodies and severe proteinuria, indicating its potential role as a marker of disease activity. However, no significant correlation was found between C4d deposition and LN classes, activity index, or complement levels (C3 and C4).
Table 1: Comparison of Clinical and Immunological Features Between C4d-Positive and C4d-Negative Lupus Nephritis Patients.
Conclusions:
The presence of glomerular C4d deposition in LN correlates with worse clinical outcomes, specifically severe proteinuria and elevated anti-dsDNA antibodies, which are markers of active disease. These findings suggest that C4d could serve as a valuable biomarker for identifying LN patients at higher risk for adverse renal outcomes, potentially guiding therapeutic decisions.
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