scholarly journals Urinary Periostin Excretion Predicts Renal Outcome in IgA Nephropathy

2016 ◽  
Vol 44 (6) ◽  
pp. 481-492 ◽  
Author(s):  
Jin Ho Hwang ◽  
Jung Pyo Lee ◽  
Clara Tammy Kim ◽  
Seung Hee Yang ◽  
Jin Hyuk Kim ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Renal Fibrosis ◽  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Glomerular Sclerosis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Matricellular Protein ◽  
Tubular Atrophy ◽  
Renal Outcomes ◽  
Group 3

Background: Periostin is a matricellular protein and plays a vital role in tissue regeneration, fibrosis and wound healing. However, data about its significance in nephrology are limited. We investigated the correlation between urinary periostin excretion and its clinical significance including renal histologic findings and prognosis in IgA nephropathy (IgAN). Methods: Of 399 patients from a glomerulonephritis cohort recruited between January 2009 and December 2014, 314 were enrolled. Serum and urine periostin (uPOSTN) were measured using enzyme-linked immunosorbent assay. We divided the patients into 3 groups by uPOSTN/creatinine (uPOSTN/Cr): group 1 (undetectable), group 2 (lower than the median) and group 3 (higher than the median). Results: The uPOSTN level was correlated with pathologic classifications and both initial and final IDMS-MDRD estimated glomerular filtration rates (eGFRs; p < 0.001). Histologically, group 3 patients were correlated with severe interstitial fibrosis/tubular atrophy (p = 0.004), interstitial inflammation (p = 0.007), hyaline arteriolosclerosis (p = 0.001) and glomerular sclerosis (p < 0.001). A higher initial uPOSTN/Cr level was associated with a greater decline in eGFR during follow-up (p = 0.043 when initial eGFR ≥60; p = 0.025 when eGFR <60 ml/min/1.73 m2), and the renal outcomes with end-stage renal disease (ESRD; p = 0.003), ESRD and/or eGFR decrease of >30% (p = 0.033) and ESRD and/or eGFR decrease of >50% (p = 0.046) occurred significantly more in group 3. In multivariate analysis, uPOSTN group 3 (hazards ratio 2.839, 95% CI 1.013-7.957; p = 0.047) was independently associated with ESRD in IgAN patients. Conclusion: uPOSTN/Cr value at initial diagnosis correlated with renal fibrosis and predicted the renal outcomes in patients with IgAN. It could be a promising urinary biomarker for renal fibrosis.

scholarly journals Urinary chemokine C-X-C motif ligand 16 and endostatin as predictors of tubulointerstitial fibrosis in patients with advanced diabetic kidney disease

2019 ◽  
Author(s):  
Yu Ho Lee ◽  
Ki Pyo Kim ◽  
Sun-Hwa Park ◽  
Dong-Jin Kim ◽  
Yang-Gyun Kim ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Enzyme Linked Immunosorbent Assay ◽  
Glomerular Injury ◽  
Tubular Atrophy ◽  
Diabetic Kidney ◽  
Cytokines And Chemokines ◽  
Pathologic Features

Abstract Background Interstitial fibrosis and tubular atrophy (IFTA) is a well-recognized risk factor for poor renal outcome in patients with diabetic kidney disease (DKD). However, a noninvasive biomarker for IFTA is currently lacking. The purpose of this study was to identify urinary markers of IFTA and to determine their clinical relevance as predictors of renal prognosis. Methods Seventy patients with biopsy-proven isolated DKD were enrolled in this study. We measured multiple urinary inflammatory cytokines and chemokines by multiplex enzyme-linked immunosorbent assay in these patients and evaluated their association with various pathologic features and renal outcomes. Results Patients enrolled in this study exhibited advanced DKD at the time of renal biopsy, characterized by moderate to severe renal dysfunction [mean estimated glomerular filtration rate (eGFR) 36.1 mL/min/1.73 m2] and heavy proteinuria (mean urinary protein:creatinine ratio 7.8 g/g creatinine). Clinicopathologic analysis revealed that higher IFTA scores were associated with worse baseline eGFR (P < 0.001) and poor renal outcome (P = 0.002), whereas glomerular injury scores were not. Among measured urinary inflammatory markers, C-X-C motif ligand 16 (CXCL16) and endostatin showed strong correlations with IFTA scores (P = 0.001 and P < 0.001, respectively), and patients with higher levels of urinary CXCL16 and/or endostatin experienced significantly rapid renal progression compared with other patients (P < 0.001). Finally, increased urinary CXCL16 and endostatin were independent risk factors for poor renal outcome after multivariate adjustments (95% confidence interval 1.070–3.455, P = 0.029). Conclusions Urinary CXCL16 and endostatin could reflect the degree of IFTA and serve as biomarkers of renal outcome in patients with advanced DKD.

scholarly journals The Correlation Analysis between the Oxford Classification of Chinese IgA Nephropathy Children and Renal Outcome -A retrospective cohort study

2019 ◽  
Author(s):  
Heyan Wu ◽  
Zhengkun Xia ◽  
Chunlin Gao ◽  
Pei Zhang ◽  
Xiao Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iga Nephropathy ◽  
Interstitial Fibrosis ◽  
Cohort Analysis ◽  
Immunosuppressive Agents ◽  
Renal Outcome ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
Independent Risk Factors

Abstract Background The 2016 Oxford Classification's MEST-C scoring system predicts outcomes in adults with IgA nephropathy, but it lacks large cohort validation in children with IgAN in China. We would like to verify that the MEST-C score can be used to predict the renal outcome of children with IgAN.Methods A retrospective cohort analysis of data from 1243 Chinese children with IgAN who underwent renal biopsy in Jinling Hospital from 2000 to 2017 was performed and investigated with glomerular filtration rate (eGFR),24h urine proteinuria(24h-UP)and blood pressure(BP) at biopsy and during follow-up.The renal pathology was based on Oxford Classification of IgAN.Results We confirm that BP was significantly correlated with mesangial hypercellullarity(M), endocapillary hypercellularity(E), tubular atrophy/ interstitial fibrosis(T) and crescents (C) .There was a significant correlation between eGFR and segmental glomerulosclerosis(S), T and C .24h-UP and all pathological indexes were significantly correlated. S and T were shown to be independent risk factors associated with renal outcomes in our group. Kaplan-Meier revealed that M [log-rank, chi-squared(χ2)=14.679, P=0.000 ], S(χ2=31.508,P=0.000),T (χ2=78.893, P=0.000),C(χ2=16.603, P=0.000) were associated with renal outcome.In univariate analyses, M(HR 2.167, 95% CI, 1.445~3.251, P = 0.000),S(HR 3.081, 95% CI, 2.038~4.658, P = 0.000), T(HR 7.911, 95% CI, 4.670~13.400,P = 0.000) and C(HR3.346, 95% CI, 1.818~6.156,P = 0.000) lesions were significant predictors of renal outcome. In a multivariate analysis, only S(HR 2.742, 95% CI, 1.805~4.164,P = 0.000) and T(HR 6.633, 95% CI, 3.897~11.289,P = 0.000)were shown to be independent risk factors .Conclusions We found that S and T lesions were valid in predicting a poor outcome in our group.E, S, T and C lesion were important basis for doctors to choose glucocorticoids and immunosuppressive agents in the treatment of IgAN, while T and C lesion were often the basis for doctors to use RAS blockers cautiously.

scholarly journals Novel urinary glycan profiling by lectin array serves as the biomarkers for predicting renal prognosis in patients with IgA nephropathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chieko Kawakita ◽  
Koki Mise ◽  
Yasuhiro Onishi ◽  
Hitoshi Sugiyama ◽  
Michihiro Yoshida ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Interstitial Fibrosis ◽  
Lectin Binding ◽  
Renal Outcome ◽  
Tubular Atrophy ◽  
Net Reclassification Improvement ◽  
Outcome Group ◽  
Lectin Array ◽  
Renal Prognosis ◽  
Glycan Profiling

AbstractIn IgA nephropathy (IgAN), IgA1 molecules are characterized by galactose deficiency in O-glycans. Here, we investigated the association between urinary glycosylation profile measured by 45 lectins at baseline and renal prognosis in 142 patients with IgAN. The primary outcome was estimated glomerular filtration rate (eGFR) decline (> 4 mL/min/1.73 m2/year), or eGFR ≥ 30% decline from baseline, or initiation of renal replacement therapies within 3 years. During follow-up (3.4 years, median), 26 patients reached the renal outcome (Group P), while 116 patients were with good renal outcome (Group G). Multivariate logistic regression analyses revealed that lectin binding signals of Erythrina cristagalli lectin (ECA) (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.11–7.28) and Narcissus pseudonarcissus lectin (NPA) (OR 2.32, 95% CI 1.11–4.85) adjusted by age, sex, eGFR, and urinary protein were significantly associated with the outcome, and they recognize Gal(β1-4)GlcNAc and high-mannose including Man(α1-6)Man, respectively. The addition of two lectin-binding glycan signals to the interstitial fibrosis/tubular atrophy score further improved the model fitness (Akaike’s information criterion) and incremental predictive abilities (c-index, net reclassification improvement, and integrated discrimination improvement). Urinary N-glycan profiling by lectin array is useful in the prediction of IgAN prognosis, since ECA and NPA recognize the intermediate glycans during N-glycosylation of various glycoproteins.

scholarly journals The Correlation Analysis between the Oxford Classification of Chinese IgA Nephropathy Children and Renal Outcome -A retrospective cohort study

2020 ◽  
Author(s):  
Heyan Wu ◽  
Zhengkun Xia ◽  
Chunlin Gao ◽  
Pei Zhang ◽  
Xiao Yang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Iga Nephropathy ◽  
Retrospective Cohort Study ◽  
Cortical Area ◽  
Retrospective Cohort ◽  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
The Oxford Classification

Abstract Background: The 2016 Oxford Classification's MEST-C scoring system predicts outcomes in adults with IgA nephropathy (IgAN), but it lacks large cohort validation in children with IgAN in China. We sought to verify whether the Oxford classification could be used to predict the renal outcome of children with IgAN. Methods : A total of 1243 Chinese children with IgAN who underwent renal biopsy in Jinling Hospital were enrolled from January 1, 2000, to December 31, 2017, in this retrospective cohort study. The primary endpoint of the study was a composite of either ≥50% reduction in estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD). We probed into the relationship between the Oxford classification and renal outcome. Results : There were 29% of children with mesangial proliferation(M1), 35% with endocapillary proliferation (E1), 37% with segmental sclerosis/adhesion lesion (S1), 23% with moderate tubular atrophy/interstitial fibrosis (T1 25–50% of cortical area involved), 4.3% with severe tubular atrophy/interstitial fibrosis (T2 >50% of cortical area involved), 44% with crescent in< 25% of glomeruli(C1), and 4.6% with crescent in>25% of glomeruli (C2).During a median follow-up duration of 7.2 (4.6–11.7) years, 171 children (14%) developed ESRD or 50% decline in eGFR. In the multivariate COX regression model, only segmental sclerosis/adhesion (HR2.7,95%CI 1.8～4.2, P ＜0.001) and tubular atrophy/interstitial fibrosis (HR6.6,95%CI 3.9～11.3, P ＜0.001) were confirmed to be independent risk factors of poor renal outcome in the whole cohort, whereas crescent showed significant association with prognosis only in children received no immunosuppressive treatment.Conclusions: This study revealed that segmental sclerosis/adhesion and tubular atrophy/interstitial fibrosis were independently associated with poor renal outcome in Chinese children with IgA nephropathy.

scholarly journals Endotrophin, a collagen type VI-derived matrikine, reflects the degree of renal fibrosis in patients with IgA nephropathy and in patients with ANCA-associated vasculitis

2021 ◽  
Author(s):  
Nadja Sparding ◽  
Federica Genovese ◽  
Daniel Guldager Kring Rasmussen ◽  
Morten Asser Karsdal ◽  
Michaela Neprasova ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Kidney Function ◽  
Renal Fibrosis ◽  
Collagen Type ◽  
Validation Cohort ◽  
Interstitial Fibrosis ◽  
Matrix Remodeling ◽  
Tubular Atrophy ◽  
Anca Associated Vasculitis ◽  
Collagen Type Vi

Abstract Background Renal fibrosis is the hallmark of chronic kidney disease (CKD) and characterized by an imbalanced extracellular matrix remodeling. Endotrophin (ETP) is a signaling molecule released from collagen type VI (COL VI). ETP can be measured by the PRO-C6 assay, which quantifies the levels of COL VI formation. ETP levels were previously associated with mortality and disease progression in patients with CKD. We hypothesized that serum and urinary ETP levels correlate with the degree of interstitial fibrosis in kidney biopsies from patients with IgA nephropathy (IgAN) and patients with ANCA-associated vasculitis (AAV). Methods We examined a cohort of 49 IgAN and 47 AAV patients. A validation cohort of 85 IgAN patients was included. ETP was measured in serum (S-ETP) and urine (U-ETP/Cr) samples, taken on the same day before renal biopsy was performed, using the ELISA PRO-C6. The biopsies were evaluated for interstitial fibrosis and tubular atrophy according to the Banff and MEST-C scores. Results S-ETP and U-ETP/Cr levels correlated with kidney function, increased with CKD severity, correlated with the extent of interstitial fibrosis and gradually increased with increasing degree of interstitial fibrosis and tubular atrophy. ETP outperformed the known fibrosis biomarker Dickkopf-3 for discrimination of patients with high fibrotic burden. The association of S-ETP and U-ETP/Cr with the level of kidney fibrosis was confirmed in the validation cohort. Conclusions We demonstrated that high levels of circulating and excreted ETP are not only indicative of lower kidney function, but also reflect the burden of fibrosis in the kidneys.

P0440EPIDEMIOLOGICAL AND CLINICAL CHARACTERSTICS OF IGA NEPHROPATHY PATIENTS IN TURKEY: TSN-GOLD WORKING GROUP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Necmi Eren ◽  
Meltem Gursu ◽  
Egemen Cebeci ◽  
Aydin Turkmen ◽  
Hasan Haci Yeter ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Clinical Data ◽  
Working Group ◽  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Pathological Features ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
Glomerular Diseases ◽  
Lower Egfr

Abstract Background and Aims According to the data of the Turkish Society of Nephrology-Glomerular Diseases Working Group (TSN-GOLD Working Group), IgA nephropathy is the most common primary glomerular disease in Turkey. The purpose of this study was to investigate the epidemiological and clinical data of IgA nephropathy patients in Turkey. Method 4399 patients with primary glomerular diseases from 47 centers who were followed up between May 2009 and May 2019 were included in the study conducted by TSN-GOLD Working Group. 524 patients were excluded due to lack of pathological data. Among the remaining patients, demographic, clinical and laboratory data of 994 patients with IgA nephropathy were analyzed. Results The median age of the patients was 37 (28-47) years, and 37.3% of them were female. The laboratory and clinical data at the time of diagnosis is presented in Figure-1, and biopsy indications are described in Figure-2. The median number of glomeruli was 16 (IQR: 3.5-4.3), sclerotic glomeruli was 2 (IQR: 1-5), and segmental sclerotic glomeruli was 1 (IQR: 1-2). Exudative changes, subendothelial and subepithelial deposition were present in 566 patients (56.9%), 46 patients (4.6%) and in 38 patients (3.8%), respectively. 662 (66.1%) and 611 of the patients (61.4%) had tubular atrophy and interstitial fibrosis in varying degrees, respectively. 672 (%67.6) and 416 patients (%41.9) had interstitial inflammation and vascular changes, respectively. In immunofluorescence staining, 18%, 30.1%, 4.4%, 68% of the patients had IgG, IgM, C1q and C3 positivity, respectively. Crescentic glomeruli were detected in 227 patients (3.3 ± 3.1 glomeruli). Patients with crescentic glomeruli had significantly higher proteinuria and lower eGFR than the patients without [2203 mg/day (15-26078) vs 1807 mg/day (15-29112); p=0.001; 55.3 ml/min/1.73 m2 (3.72-141.9) vs 72 ml/min/1.73 m2 (3.84-150.81); p&lt;0.001, respectively]. Oxford classification was applied to 544 patients. Endocapillary hypercellularity (E1), mesengial hypercellularity (M1), tubular atrophy and interstitial fibrosis (T1 and T2), segmental sclerosis (S1) were present in 126 (13%), 425 (42.8%), 306 (30.8%) and 325 patients (%32.7), respectively. Proteinuria levels were higher in patients with endocapillary hypertrophy, mesengial hypercellularity, tubular atrophy-interstitial fibrosis and segmental sclerosis. eGFR levels were lower in patients with endocapillary hypertrophy, tubular atrophy-interstitial fibrosis and segmental sclerosis (Figure-3). Conclusion In this study we found that, the most common presentation of IgA nephropathy patients in our country was asymptomatic urinary abnormalities followed by nephritic and nephrotic syndrome. Higher proteinuria and lower eGFR values in patients with crescentic glomeruli, support the adoption of crescentic lesions in the new Oxford classification (MEST-C) to predict more precise outcome of IgA nephropathy patients. The high number of patients to whom the Oxford classification was applied provided us with the opportunity to examine the clinical reflections of pathological features. Evaluation of the follow-up data of the patients will give us the possibility to reveal the effect of initial clinical and pathological features on clinical findings and renal outcome.

scholarly journals Serum uric acid level is correlated with the clinical, pathological progression and prognosis of IgA nephropathy: an observational retrospective pilot-study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e10130
Author(s):  
Pingfan Lu ◽  
Xiaoqing Li ◽  
Na Zhu ◽  
Yuanjun Deng ◽  
Yang Cai ◽  
...  
Keyword(s):  
Uric Acid ◽  
Iga Nephropathy ◽  
Serum Uric Acid ◽  
Interstitial Fibrosis ◽  
Serum Uric Acid Level ◽  
Immunoglobulin M ◽  
Complement C3 ◽  
Renal Outcome ◽  
Glomerular Sclerosis ◽  
Significant Difference

Objectives This study was aimed to assess the relationship between serum uric acid (SUA) level and the clinical, pathological phenotype of IgA nephropathy (IgAN), and to determine the role of SUA level in the progression and prognosis of IgAN. Methods A total of 208 patients with IgAN were included in this study, and were classified into the normo-uricemia group and hyperuricemia group according to the SUA level. The clinical data at baseline, IgAN Oxford classification scores (MEST-C scoring system), and other pathological features were collected and further analyzed. All patients were followed up and the prognosis was assessed using Kaplan-Meier survival curves. GraphPad Prism 7.0 and SPSS 23.0 were used for statistical analyses. Results In clinical indicators, patients with hyperuricemia had the significantly higher proportion of males to females, mean arterial pressure, the levels of total cholesterol, triglyceride, Scr, BUN, 24 hour-urine protein, C3, and C4, the lower levels of high-density lipoprotein cholesterol and eGFR than those without (p < 0.05). In terms of pathological characteristics, the tubular atrophy/interstitial fibrosis scores, vascular injury scores, and glomerular sclerosis percentage were significantly higher in patients with hyperuricemia compared with those without (p < 0.01). There was no significant difference in the scores of mesangial hypercellularity, endocapillary hypercellularity, focal segmental glomerulosclerosis, as well as crescents between the two groups (p > 0.05). As for the depositions of immune complexes deposition in IgAN, the hyperuricemia group had less deposition of immunoglobulin G and FRA than the normo-uricemia group (p < 0.05), while the deposition of immunoglobulin A, immunoglobulin M, and complement C3 in the two groups showed no statistical difference. The survival curve suggested that patients in the hyperuricemia group have significantly poorer renal outcome than those in the normo-uricemia group (p = 0.0147). Results also revealed that the SUA level is a valuable predictor of renal outcome in patients with IgAN. The optimal cutoff value was 361.1 µmol/L (AUC = 0.76 ± 0.08167) and 614 µmol/L (AUC = 0.5728 ± 0.2029) for female and male, respectively. Conclusions The level of SUA is associated with renal function level and pathological severity of IgAN, and maybe a prognostic indicator of IgAN.

scholarly journals The Relationship between Cigarette Smoking and IgA Nephropathy

2021 ◽  
Author(s):  
Siqing Wang ◽  
Aiya Qin ◽  
Gaiqin Pei ◽  
Zheng Jiang ◽  
Lingqiu Dong ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
Iga Nephropathy ◽  
Cox Regression ◽  
Interstitial Fibrosis ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Renal Outcome ◽  
Study Endpoint ◽  
Tubular Atrophy ◽  
Cox Regression Analysis

Abstract Background and aim: Regarding that whether cigarette smoking is associated with the progression of IgA nephropathy (IgAN) remains uncertain, we aimed to evaluate the effect of cigarette smoking on the prognosis of IgAN.Methods: 1239 IgAN patients who meet inclusion criteria from West China Hospital of Sichuan University were divided into smoker and non-smoker group. The endpoint was end stage renal disease (ESRD: eGFR <15 mL/min/1.73 m2 or having renal replacement treatment) and/or eGFR decreased>50%. Kaplan-Meier and Cox proportional hazards analyses were performed. Association of cigarette smoking and IgAN was further verified by propensity-score-matched cohort analysis.Results: During the mean follow-up period of 61 months, 40 out of 209 (19%) patients in smoker group and 110 out of 1030 (11%) in non-smoker group reached study endpoint(p<0.001). Multivariate Cox regression analysis revealed that cigarette smoking (HR=1.58,p=0.043), female gender (HR=2.00,p=0.002), Hypertension (HR=1.50,p=0.029), Serum creatinine (HR=1.01,p<0.001), segmental glomerulosclerosis (HR=1.59,p=0.026), and tubular atrophy/interstitial fibrosis (HR=3.13,p<0.001) were independent risk factors for prediction of poor renal outcome of IgAN. After matching with propensity scores, the significant correlation between cigarette smoking and the renal outcomes of IgAN patients can be seen.Conclusion: Smoking is an independent risk factor for the progression of IgAN, especially for female subjects.

scholarly journals A multicenter, prospective, observational study to determine association of mesangial C1q deposition with renal outcomes in IgA nephropathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Li Tan ◽  
Yi Tang ◽  
Gaiqin Pei ◽  
Zhengxia Zhong ◽  
Jiaxing Tan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iga Nephropathy ◽  
Cox Regression ◽  
Renal Outcome ◽  
Matched Cohort ◽  
Negative Group ◽  
Renal Survival ◽  
Cox Regression Analysis ◽  
Renal Outcomes

AbstractIt was reported that histopathologic lesions are risk factors for the progression of IgA Nephropathy (IgAN). The aim of this study was to investigate the relationships between mesangial deposition of C1q and renal outcomes in IgAN. 1071 patients with primary IgAN diagnosed by renal biopsy were enrolled in multiple study centers form January 2013 to January 2017. Patients were divided into two groups: C1q-positive and C1q-negative. Using a 1: 4 propensity score matching (PSM) method identifying age, gender, and treatment modality to minimize confounding factors, 580 matched (out of 926) C1q-negative patients were compared with 145 C1q-positive patients to evaluate severity of baseline clinicopathological features and renal outcome. Kaplan–Meier and Cox proportional hazards analyses were performed to determine whether mesangial C1q deposition is associated with renal outcomes in IgAN. During the follow-up period (41.89 ± 22.85 months), 54 (9.31%) patients in the C1q negative group and 23 (15.86%) patients in C1q positive group reached the endpoint (50% decline of eGFR and/or ESRD or death) respectively (p = 0.01) in the matched cohort. Significantly more patients in C1q negative group achieved complete or partial remission during the follow up period (P = 0.003) both before and after PSM. Three, 5 and 7-year renal survival rates in C1q-positive patients were significantly lower than C1q-negative patients in either unmatched cohort or matched cohort (all p < 0.05). Furthermore, multivariate Cox regression analysis showed that independent risk factors influencing renal survival included Scr, urinary protein, T1-T2 lesion and C1q deposition. Mesangial C1q deposition is a predictor of poor renal survival in IgA nephropathy.Trial registration TCTR, TCTR20140515001. Registered May 15, 2014, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1074.

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