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    Could mesangial C3 deposition be an independent prognostic marker in immunoglobulin A nephropathy?
    (Springer Heidelberg, 2023) Cetinkaya, Hakki; Gursu, Meltem; Yazici, Halil; Cebeci, Egemen; Eren, Necmi; Altiparmak, Mehmet Riza; Akcay, Omer Faruk
    Background: Immunoglobulin A nephropathy (IgAN) is a common primary glomerulonephropathy. There is evidence that mesangial C3 deposition plays a role in the development of the disease. The aim of this study was to examine the effect of C3 deposition on the prognosis of IgAN patients.Method: The study included 1135 patients with biopsy-confirmed IgAN from the database of the Turkish Nephrology Association Glomerular Diseases Working Group (TSN-GOLD). Patients were excluded from the study if they were aged < 18 or > 75 years or if C3 staining had not been performed in the immunofluorescent analysis. C3 deposition was defined as an immunofluorescence intensity of C3 >= 2 + within the mesangium. The primary endpoints were the development of end-stage renal disease, a 30% decrease in glomerular filtration rate compared to the basal value or an elevation in proteinuria to a nephrotic level (3.5 gr/day).Results: Mesangial C3 deposition was observed in 603 (53.1%) patients. No statistically significant difference was found at baseline between the groups with and without mesangial C3 deposition, as for age, sex, BMI, proteinuria level, or the presence of hypertension. In the follow-up period with a mean duration of 78 months, no significant difference was found between the two groups regarding the primary endpoints (p = 0.43). A significant correlation between C3 deposition and segmental glomerulosclerosis (S1) according to the Oxford MEST-C classification was found (p = 0.001).Conclusion: Although a correlation was observed between mesangial C3 deposition and the S1 MEST-C classification, mesangial C3 deposition was not a prognostic factor in IgAN.
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    COULD MESANGIAL C3 DEPOSITION BE AN INDEPENDENT PROGNOSTIC MARKER IN IMMUNOGLOBULIN A NEPHROPATHY?
    (Oxford Univ Press, 2023) Cetinkaya, Hakki; Gursu, Meltem; Yazici, Halil; Cebeci, Egemen; Eren, Necmi; Altiparmak, Mehmet Riza; Akcay, Omer Faruk
    [Abstract Not Available]
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    IMMUNOSUPPRESSIVE TREATMENT RESULTS IN PATIENTS WITH PRIMARY IGA NEPHROPATHY IN TURKIYE: A NATIONWIDE STUDY
    (Oxford Univ Press, 2023) Oruc, Aysegul; Sumnu, Abdullah; Turkmen, Aydin; Basturk, Taner; Cebeci, Egemen; Turgutalp, Kenan; Cetinkaya, Hakki
    [Abstract Not Available]
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    Immunosuppressive treatment results in patients with primary IgA nephropathy in Turkiye; the data from TSN-GOLD working group
    (Taylor & Francis Ltd, 2024) Oruc, Aysegul; Sumnu, Abdullah; Turkmen, Aydin; Basturk, Taner; Cebeci, Egemen; Turgutalp, Kenan; Cetinkaya, Hakki
    BackgroundImmunoglobulin A (IgA) nephropathy (IgAN) treatment consists of maximal supportive care and, for high-risk individuals, immunosuppressive treatment (IST). There are conflicting results regarding IST. Therefore, we aimed to investigate IST results among IgAN patients in Turkiye.MethodThe data of 1656 IgAN patients in the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases Study Group were analyzed. A total of 408 primary IgAN patients treated with IST (65.4% male, mean age 38.4 +/- 12.5 years, follow-up 30 (3-218) months) were included and divided into two groups according to treatment protocols (isolated corticosteroid [CS] 70.6% and combined IST 29.4%). Treatment responses, associated factors were analyzed.ResultsRemission (66.7% partial, 33.7% complete) was achieved in 74.7% of patients. Baseline systolic blood pressure, mean arterial pressure, and proteinuria levels were lower in responsives. Remission was achieved at significantly higher rates in the CS group (78% vs. 66.7%, p = 0.016). Partial remission was the prominent remission type. The remission rate was significantly higher among patients with segmental sclerosis compared to those without (60.4% vs. 49%, p = 0.047). In the multivariate analysis, MEST-C S1 (HR 1.43, 95% CI 1.08-1.89, p = 0.013), MEST-C T1 (HR 0.68, 95% CI 0.51-0.91, p = 0.008) and combined IST (HR 0.66, 95% CI 0.49-0.91, p = 0.009) were found to be significant regarding remission.ConclusionCS can significantly improve remission in high-risk Turkish IgAN patients, despite the reliance on non-quantitative endpoints for favorable renal outcomes. Key predictors of remission include baseline proteinuria and specific histological markers. It is crucial to carefully weigh the risks and benefits of immunosuppressive therapy for these patients.