Short-term renal and patient outcomes of primary immunoglobulin-associated mesangiocapillary glomerulonephritis: Insights from a developing country

Table 1 Clinical and laboratory characteristics at the time of presentation of patients with primary immunoglobulin associated mesangiocapillary glomerulonephritis

Characteristics	Data among total, n = 163
Age at biopsy in years	32 (22-42)
Sex
Male	79 (48.4)
Female	84 (51.5)
Hypertension	57 (35)
Serum creatinine in mg/dL	2.7 ± 2.9
Estimated glomerular filtration rate in mL/minute/1.73 m2	53.65 ± 37.7
Serum albumin in g/dL	2.3 ± 0.79
Proteinuria by dipstick
Trace	5 (3.1)
1+	17 (10.7)
2+	20 (12.6)
3+	76 (46.6)
4+	45 (27.6)
Microscopic hematuria
Trace	8 (4.9)
1+	17 (10.4)
2+	18 (11.04)
3+	77 (47.2)
4+	43 (26.3)
Spot protein-to-creatinine ratio in mg/dL	3.55 ± 3.19
24-hour urinary protein in g/day	4.0 ± 2.61
Serum C3 levels
Low, < 0.8 g/L	87 (53.7)
Normal, > 0.8 g/L	76 (46.3)
Serum C4 levels
Low, < 0.16 g/L	40 (24)
Normal, > 0.16 g/L	124 (76)
Required kidney replacement therapy	43 (26.4)
Indications for renal biopsy
Nephrotic	27 (16.6)
Nephritic	30 (18.4)
Acute kidney injury	106 (65)

Data are n (%), median (interquartile range) or mean ± standard deviation.

Table 2 Histopathological characteristics of patients with primary immunoglobulin associated mesangiocapillary glomerulonephritis

Characteristics	Data
Total glomeruli	20.36 ± 10.4
Globally sclerosed	2.05 ± 3.5
Presence of crescents	57 (35.6)
Mesangial proliferation
Focal	37 (22.6)
Diffuse	126 (77.4)
Presence of spikes	15 (9.4)
Arteriolosclerosis	56 (34.8)
Interstitial fibrosis and tubular atrophy
None	22 (13.49)
Mild	103 (63.1)
Moderate	35 (21.2)
Severe	3 (1.84)
Immunofluorescence results
IgA
Negative	124 (76.1)
Trace	18 (11)
1+	19 (11.7)
2+	2 (2)
3+	0
IgG
Negative	0
Trace	1 (0.6)
1+	17 (10.4)
2+	96 (58.8)
3+	49 (30.06)
IgM
Negative	74 (45.4)
Trace	30 (18.4)
1+	43 (26.4)
2+	11 (6.7)
3+	5 (3.1)
C3
Negative	24 (14.7)
Trace	43 (26.4)
1+	70 (42.9)
2+	17 (10.4)
3+	9 (5.5)
C1q
Negative	91 (55.8)
Trace	17 (10.4)
1+	28 (17.1)
2+	23 (14.1)
3+	4 (2.45)

Data are n (%) or mean ± standard deviation.

Table 3 Treatment and renal outcomes in patients with and without the requirement of kidney replacement therapy on presentation over 2 years

Parameters	Overall, n = 163	KRT required on presentation, n = 43	KRT not required on presentation, n = 120	P value
Steroids alone	62 (38.0)	21 (48.83)	41 (34.16)	0.08
CR	9 (5.52)	2 (4.65)	7 (5.83)	0.42
PR	36 (22.08)	3 (6.97)	33 (27.5)	< 0.001
ESKD	12 (7.36)	12 (27.90)	0	< 0.001
Mortality	5 (3.06)	4 (9.30)	1 (0.83)	0.04
Cyclophosphamide + steroids	21 (12.8)	5 (11.62)	16 (13.33)	0.13
CR	4 (2.45)	0	4 (3.33)	0.53
PR	13 (7.97)	1 (2.32)	12 (10)	0.02
ESKD	3 (1.84)	3 (6.97)	0	< 0.001
Mortality	1 (0.61)	1 (2.32)	0	0.06
Renal outcomes at 2 years
CR	56 (34.3)	3 (6.97)	53 (44.1)	< 0.001
PR	68 (41.71)	5 (11.6)	63 (52.5)	< 0.001
ESKD	32 (19.63)	29 (67.41)	3 (2.5)	< 0.001
Mortality	7 (4.29)	6 (13.9)	1 (0.83)	0.001

Data are n (%). CR: Complete remission; ESKD: End-stage kidney disease; KRT: Kidney replacement therapy; PR: Partial remission.

Table 4 Comparison between renal outcomes and baseline clinicopathological parameters in patients with primary immunoglobulin-associated mesangiocapillary glomerulonephritis

Variables	Complete remission, n = 56	Partial remission, n = 68	End-stage kidney disease, n = 32	Mortality, n = 7	P value
Age in years	32.71 ± 9.84	35.71 ± 13.4	28.44 ± 11.41	29.86 ± 13.50	0.03
Hypertension	24 (42.85)	21 (30.8)	10 (31.25)	2 (28.57)	0.50
Serum creatinine in mg/dL	1.94 ± 1.43	2.36 ± 2.52	4.51 ± 4.49	4.69 ± 4.12	< 0.001
Serum albumin in g/dL	2.72 ± 0.76	2.23 ± 0.76	1.78 ± 0.59	1.90 ± 0.50	< 0.001
protein-to-creatinine ratio in g/dL	3.93 ± 0.879	3.73 ± 0.595	4.22 ± 0.553	3.86 ± 3.78	0.114
Estimated glomerular filtration rate in mL/minute/1.73 m2	60.33 ± 31.07	57.87 ± 41.83	38.54 ± 37.14	28.20 ± 18.31	0.01
Required kidney replacement therapy on admission	3 (5.35)	5 (7.35)	29 (90.62)	6 (85.71)	< 0.001
Serum C3 levels
Low, < 0.8 g/L	27 (48.21)	31 (45.5)	17 (53.12)	4 (57.14)	0.84
Normal, > 0.8 g/L	24 (42.85)	30 (44.11)	11 (34.37)	3 (42.85)
Serum C4 levels
Low, < 0.16 g/L	17 (30.35)	13 (19.11)	4 (12.5)	1 (14.28)	0.19
Normal, > 0.16 g/L	33 (58.92)	49 (72)	24 (75)	5 (71.42)
Number of globally sclerosed glomeruli	0.45 ± 0.80	1.75 ± 2.42	5.27 ± 5.64	3.86 ± 5.36	< 0.001
Presence of crescents	10 (17.85)	25 (36.7)	17 (53.12)	5 (71.42)	< 0.001
Mesangial/endocapillary proliferation
Focal	17 (30.35)	15 (22)	4 (12.5)	0	0.128
Diffuse	39 (69.64)	52 (76.47)	28 (87.5)	7 (100)
Presence of spikes	0	12 (17.6)	3 (9.37)	0	0.006
Interstitial fibrosis and tubular atrophy
None	16 (28.57)	5 (7.35)	2 (6.25)	0
Mild	37 (66.07)	49 (72)	14 (43.75)	1 (14.28)	< 0.001
Moderate	3 (5.35)	13 (19.11)	13 (40.62)	6 (85.71)
Severe	0	0	3 (9.37)	0

Data are n (%) or mean ± standard deviation.