| Objective: Complement activation are common in patients with IgA nephropathy(IgAN). However, the effects of low serum C3 levels and the activation of the complement system on the development and the prognosis of IgAN are unclear. All of patients were subjected to 1:1 propensity score matching, investigating the correlation of clinical and pathological features and their influences on the prognosis of IgA nephropathy with decreased Serum C3 Levels.Methods: In the first part, a total of 496 eligible patients with primary IgAN diagnosed by pathological examination via renal biopsy at the Chinese PLA General Hospital from January 2011 to March 2015. A 1:1 propensity score matching method was used, and a total of 107 patients with decreased serum C3 levels and 107 patients with normal serum C3 levels were included. Clinical and Pathological Features are recorded before and after PSM. Other data recorded in EXCEL database include height,weight, body mass index (BMI), blood pressure, mean arterial blood pressure,determination of blood, urine and other clinical laboratory indicators, as well as treatment modalities.In the second part, the study subjects were followed up, including the use of serum creatinine and test time, the use of RAS blockers, hormones and other immunosuppressive agents during follow-up, and whether there was a kidney replacement therapy (dialysis or kidney transplant). The follow-up date ended December 2016. The endpoint of this study was the doubling of the baseline serum creatinine and developing into ESRD. Date of the number of patients and their follow-up time were calculated before and after PSM. The Kaplan-Meier curves method uses to showing the probability of kidney survival and the log-rank test was used to compare the survival between two groups. Risk ratios (HR) and 95% confidence intervals (CI) were calculated using estimated regression coefficients and standard errors in Cox regression analysis.Results: The first part of the study suggested that before matching, the patients with decreased C3 level group had serious Pathological changes. The patients in the two groups exhibited significant differences in age, gender, BMI, albumin, serum creatinine,eGFR, triglycerides, and other baseline indicators. After matching, there were no significant differences between two groups.In the second part, there was no significant difference in the follow-up time between the two groups. In the unmatched cohort, Kaplan-Meier survival analysis was performed on patients in the two groups, the renal survival rate of the group with decreased C3 levels was lower than that of the group with normal C3 levels. When analyzing a single endpoint, the renal survival rate of patients who achieved D-SCr in the group with decreased C3 levels was lower than that of group with normal C3 levels.After matching, There were no significant differences between groups in the individual kidney outcome of D-SCr (4.7% vs. 4.7%, P=1) or ESRD. In a multivariate Cox analysis adjusted for unbalanced factors, the risk of reaching renal outcome was comparable in two groups (HR, 0.70; 95% CI, 0.27-1.78; P =0.449). Furthermore, the risk of developing D-SCr (HR, 1.45; 95% CI, 0.20-10.60; P =0.718) and ESRD (HR,0.83; 95% Cl, 0.25-2.75; P=0.757) had not difference between the two groups.Kaplan-Meier survival analysis (Figure 2 D-F) was performed on the patients of the two groups after matching, which showed no significant difference in the overall endpoint events (P > 0.05).Conclusions: There were no significant differences between groups in renal survival rate. Furthermore, Cox analysis data were also consistent with the above results,suggesting that decreased serum C3 levels was not a independent risk factors for progression. Follow-up studies should expand the age range and increase the sample size, and need to conduct a long-term follow-up study to verify the conclusions of the present study. |
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