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Kidney Int. 2017 Oct;92(4):942-952. doi: 10.1016/j.kint.2017.03.043. Epub 2017 Jun 30.

Circulating complement factor H-related proteins 1 and 5 correlate with disease activity in IgA nephropathy.

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Centre for Complement and Inflammation Research, Imperial College London, UK.
Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK.
Histocompatibility & Immunogenetics, Imperial College Healthcare NHS Trust, London, UK.
Renal and Vascular Inflammation Section, Imperial College London, UK.
Department of Twin Research and Genetic Epidemiology, King's College London, UK.
Centre for Complement and Inflammation Research, Imperial College London, UK. Electronic address:


IgA nephropathy (IgAN) is a common cause of chronic kidney disease and end-stage renal failure, especially in young people. Due to a wide range of clinical outcomes and difficulty in predicting response to immunosuppression, we need to understand why and identify which patients with IgAN will develop progressive renal impairment. A deletion polymorphism affecting the genes encoding the complement factor H-related protein (FHR)-1 and FHR-3 is robustly associated with protection against IgAN. Some FHR proteins, including FHR-1 and FHR-5, antagonize the ability of complement factor H (fH), the major negative regulator of the complement alternative pathway, to inhibit complement activation on surfaces, a process termed fH deregulation. From a large cohort of patients, we demonstrated that plasma FHR-1 and the FHR-1/fH ratio were elevated in IgAN and associated with progressive disease. Plasma FHR-1 negatively correlated with eGFR but remained elevated in patients with IgAN with normal eGFR. Serum FHR5 was slightly elevated in IgAN but did not correlate with eGFR. Neither FHR5 levels nor the FHR-5/fH ratio was associated with progressive disease. However, higher serum FHR-5 levels were associated with a lack of response to immunosuppression, the presence of endocapillary hypercellularity, and histology scores of disease severity (the Oxford Classification MEST score). Thus, FHR-1 and FHR-5 have a role in IgAN disease progression.


IgA nephropathy; complement; glomerular disease

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