Glomerular IgG deposition is frequently observed in patients with IgA nephropathy. However, the association between glomerular IgG deposition and progression of IgA nephropathy is uncertain. Six hundred and twentyseven patients with biopsy-proven IgA nephropathy were recruited. Histological variables of the Oxford classification (Oxford-MEST) and the presence of glomerular IgG deposits were assessed. Renal progression defined as end-stage renal disease or 50% reduction in estimated glomerular filtration rate was analyzed using Kaplan-Meier methods and Cox regression analysis. Of the study population, 200 patients (31.9%) had glomerular IgG deposition on immunofluorescence staining. During a mean follow-up of 56.8 ± 37.5 months, the rate of renal progression was significantly higher in the IgA nephropathy patients with glomerular IgG deposition compared with the IgA nephropathy patients without glomerular IgG deposition (39.8 vs 12.3 per 1000 patientyears; Po 0.001). Of patients with IgG deposition, 178 (28.3%), 20 (3.2%), and 2 (0.3%) patients had mild, moderate, and marked glomerular IgG deposits, receptively. Kaplan-Meier analysis revealed that cumulative renal survival was significantly lower in IgA nephropathy patients with the higher intensity of glomerular IgG deposits (Po 0.001). In addition, Cox regression analysis revealed that moderate and marked glomerular IgG deposits significantly predicted renal outcome independent of Oxford-MEST and clinical variables (HR, 2.97; 95% CI, 1.01-8.77; P = 0.04). This study showed that that glomerular IgG deposition was independently associated with poor renal outcome in patient with IgA nephropathy.

BackgroundDelta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocytes in acute infection, has been reported as a useful marker for predicting mortality in patients with sepsis. The aim of this study was to evaluate the prognostic value of DNI in predicting mortality in septic acute kidney injury (S-AKI) patients treated with continuous renal replacement therapy (CRRT).MethodThis is a retrospective analysis of consecutively CRRT treated patients. We enrolled 286 S-AKI patients who underwent CRRT and divided them into three groups based on the tertiles of DNI at CRRT initiation (high, DNI > 12.0%; intermediate, 3.6–12.0%; low, < 3.6%). Patient survival was estimated with the Kaplan-Meier method and Cox proportional hazards models to determine the effect of DNI on the mortality of S-AKI patients.ResultsPatients in the highest tertile of DNI showed higher Acute Physiology and Chronic Health Evaluation II score (highest tertile, 27.9 ± 7.0; lowest tertile, 24.6 ± 8.3; P = 0.003) and Sequential Organ Failure Assessment score (highest tertile, 14.1 ± 3.0; lowest tertile, 12.1 ± 4.0; P = 0.001). The 28-day mortality rate was significantly higher in the highest tertile group than in the lower two tertile groups (P < 0.001). In the multiple Cox proportional hazard model, DNI was an independent predictor for mortality after adjusting multiple confounding factors (hazard ratio, 1.010; 95% confidence interval, 1.001–1.019; P = 0.036).ConclusionThis study suggests that DNI is independently associated with mortality of S-AKI patients on CRRT.

FederationIntroduction and Aims: Loss of podocytes in primary glomerulopathies is crucial for glomerulosclerosis progression which leads to end-stage renal failure in such patients. The mechanism of direct replacement of injured podocytes does not exist so the only way to compensate the integrity of glomerulus is change of cells shape to cover the glomerular tuft with a smaller number of podocytes. Foot process effacement is the typical morphological sign of podocyte respond to stress. Podocyte detachment (PD) from glomerular basement membrane (GBM) develops when podocyte hypertrophy is unsufficient. The aim of investigation was estimation of relationship between range of foot process width (FPW), PD and level of daily proteinuria in patients with primary variants of glomerulopathies. Methods: 42 patients with biopsy proven primary glomerulopathies were included in the study. According to the the results of light and electron microscopy 17 (40,5%) patients had membranous nephropathy, 8 (19,0%) -focal segmental glomerulosclerosis, 12 (28,6%) -minimal change disease and 5 (11,9%) -proliferative variants of glomerulonephritis (2-IgA-nephropathy, 3 -membrano-proliferative glomerulonephritis). Standart laboratory and instrumental investigations were perfomed. Samples of serum and urine were obtained in the day of byopsy. FPW and PD were measured using Image J software (NIH, 1997). FPW was counted as ratio of GBM length to amount of foot processes in every electronogramm using correction factor π/4 as described in previous works. PD was calculated as percentage of bare areas of GBM. Results: There were no statistically significant differences between FPW and PD in patients with different forms of glomerulopathies ( p>0,05). There was negative correlation between 31, p<0,05). Daily proteinuria rate positively correlated with FPW (r=0,52, p<0,05) while inverted relation with level of PD was found (r=-0,36, p<0,05). The same pattern was detected comparing groups of patients with and without nephrotic syndrome. The level of daily proteinuria was higher in patients with more expressed hyaline droplet degeneration of tubular epithelial cells. Conclusions: Unlike data published in recent works we found no difference of FPW and PD rate in patients with different forms of glomerulonephritis. Strong positive correlation of FPW with proteinuria range confirms the role of podocytes in development of high proteinuria and nephrotic syndrome, considering that there were no abnormalities in tubular reabsorbtion of protein. Interestingly the detachment of podocytes from GBM does not increase proteinuria range, more over inverse relationship was detected. Probably this fact can be explained by unknown mechanisms of transcellular transport of protein rather than directly through bare parts of GBM. Nagoya University Graduate School of Medicine, Nagoya, Japan Introduction and Aims: The clinicopathological characteristics of PLA2R-related membranous nephropathy (MN) in Japan remain unclear. Methods: We studied retrospectively the outcomes ...