![]() reported that patients with higher serum IgA/C3 ratios were more likely to be diagnosed with IgAN. Some researchers have reported that IgAN patients usually have higher serum IgA and GdIgA1 levels, alongside normal-to-low serum C3 levels, compared to those of patients with other types of primary glomerulonephritis. However, the correlation between the changes in serum complement levels and diagnosis remains unclear. Previous studies have shown that IgA deposition in the mesangial area is necessary for IgAN progression and accompanying C3 deposition. Although renal biopsy remains the gold standard for IgAN diagnosis, recent efforts have sought to find new biomarkers that can predict IgAN without the need for biopsy. put forward a four-hit hypothesis, in which the galactose-deficient IgA1 (GdIgA1) molecule plays a key pathogenic role. According to recent studies, IgAN is thought to be autoimmune in nature. However, the pathogenesis of IgAN remains unclear. Until present, the diagnosis of IgAN relies on revealing IgA as the dominant or codominant immunoglobulin in the glomerular mesangium by kidney biopsy. IgAN was previously considered to be a benign condition, but recent studies have demonstrated that up to 25–40% of patients progress to uremia within 10–20 years after the diagnostic biopsy. The stereotypical IgAN patient is a young adult with asymptomatic microscopic hematuria or episodic macroscopic hematuria occurring during an upper respiratory tract infection. The clinical presentation of IgAN is highly variable between individuals, and ranges from a subclinical disease with isolated microscopic hematuria to severe end-stage renal disease (ESRD). ![]() IgAN is diagnosed by renal biopsy with immunofluorescence staining or immunohistochemistry, and is histologically characterized by the presence of polymeric IgA deposits in glomerular mesangial areas. An epidemiological survey showed that approximately 45% of the cases of primary glomerulonephritis in China were IgAN. IgAN accounts for more than 20% of glomerular diseases. Immunoglobulin A nephropathy (IgAN), which was initially described by Berger and Hinglais in 1968, is the most common type of primary glomerulonephritis worldwide, especially in the Asia-Pacific region. In order to study the effectiveness of this biomarker, and to determine a standardized cut-off value, additional multicenter large-scale studies are needed. ![]() The present study provides clear evidence that the IgA/C3 ratio is an effective predictor of IgA diagnosis, especially in patients with proteinuria ≤1 g/d. IgAN was independently correlated with IgA/C3 ratio in the full cohort by multivariate logistic regression analysis. ![]() Meanwhile, the diagnostic accordance rate for the diagnosis of IgAN among all patients with an IgA/C3 ratio > 3.5304 was as high as 92.02% in the full cohort. The highest AUROC of the IgA/C3 ratio was in the ≤1 g/d proteinuria group (0.801 in the full cohort, and 0.803 in the PSM cohort) however, there was no difference between all CKD groups. The area under the ROC curve (AUROC) of the IgA/C3 ratio in distinguishing IgAN among primary glomerular disease was 0.767 in the full cohort, and 0.734 in the PSM cohort. In the PSM cohort, there was no difference in IgA/C3 ratio in patients with IgAN between different proteinuria groups and different chronic kidney disease (CKD) groups. The same results were also obtained with stratification by different levels of proteinuria and renal function. We found that in both the full cohort and PSM cohort, the IgA/C3 ratio in the IgAN group was significantly higher than that of the non-IgAN group. IgAN cases were propensity score matched (PSM) to non-IgAN cases on the logit of the propensity score using nearest neighbor matching in a 1:1 fashion, with a caliper of 0.02 with no replacements, according to age, gender, BMI, proteinuria level, and estimated glomerular filtration rate (eGFR). Patient demographics, serum immunological indices, and other clinical examinations were measured. We recruited 1095 biopsy-diagnosed primary glomerular nephropathy patients, including 757 IgAN patients and 338 non-IgAN patients. ![]() This study sought to explore the diagnostic value of the IgA/C3 ratio in IgAN among primary glomerular nephropathy patients in China. The serum immunoglobulin A (IgA)/C3 ratio is considered to be an effective predictor of IgA nephropathy (IgAN). ![]()
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