tetano
Editor, Senior Moderator
Kidney Int Rep
. 2024 Aug 10;9(11):3145-3155.
doi: 10.1016/j.ekir.2024.08.006. eCollection 2024 Nov. SARS-CoV-2 Protein Deposition Enhances Renal Complement Activation and Aggravates Kidney Injury in Membranous Nephropathy After COVID-19
Guoqin Wang[SUP] 1 [/SUP], Lei Yang[SUP] 1 [/SUP], Xiaoyi Xu[SUP] 1 [/SUP], Weiyi Guo[SUP] 1 [/SUP], Lijun Sun[SUP] 1 [/SUP], Yanyan Wang[SUP] 1 [/SUP], Wenrong Cheng[SUP] 1 [/SUP], Nan Ye[SUP] 1 [/SUP], Lingqiang Kong[SUP] 1 [/SUP], Xiaoyi Zhao[SUP] 2 [/SUP], Hong Cheng[SUP] 1 [/SUP]
Affiliations
Introduction: COVID-19 has been reported to be associated with the occurrence and recurrence of membranous nephropathy (MN). The clinicopathological characteristics and complement system activation of MN after COVID-19 are unclear.
Methods: A total of 38 patients with biopsy-proven MN who developed new-onset proteinuria after COVID-19 were enrolled in this study. One hundred patients with primary MN diagnosed before the COVID-19 pandemic were the control. Renal immunohistochemical staining for SARS-CoV-2 nucleocapsid protein was performed in 38 patients with MN after COVID-19. Serum membrane attack complex (MAC) was detected by enzyme-linked immunosorbent assay. Glomerular staining for the complement proteins in different pathways were detected by immunohistochemistry.
Results: Thirteen of 38 patients had positive staining for SARS-CoV-2 nucleocapsid protein. Compared with the control patients, the clinical manifestations were more severe in patients after COVID-19. Patients with positive SARS-CoV-2 staining had a higher proportion of nephrotic syndrome, lower level of serum albumin, and greater severity of renal interstitial fibrosis than those of patients with negative SARS-CoV-2 staining. Serum MAC level and renal MAC staining intensity of MN after COVID-19 were significantly higher than those of the control patients. MAC expression in MN patients with positive SARS-CoV-2 staining was stronger than that in both control patients and MN after COVID-19 with negative SARS-CoV-2 staining. The expression trend of factor H was consistent with that of MAC.
Conclusion: Excessive activation of the complement system aggravated symptoms in MN after COVID-19. Therapeutic strategy targeting the complement system may need to be considered.
Keywords: complement; coronavirus disease 2019; factor H; membranous nephropathy; severe acute respiratory syndrome corona virus 2; the alternative pathway.
. 2024 Aug 10;9(11):3145-3155.
doi: 10.1016/j.ekir.2024.08.006. eCollection 2024 Nov. SARS-CoV-2 Protein Deposition Enhances Renal Complement Activation and Aggravates Kidney Injury in Membranous Nephropathy After COVID-19
Guoqin Wang[SUP] 1 [/SUP], Lei Yang[SUP] 1 [/SUP], Xiaoyi Xu[SUP] 1 [/SUP], Weiyi Guo[SUP] 1 [/SUP], Lijun Sun[SUP] 1 [/SUP], Yanyan Wang[SUP] 1 [/SUP], Wenrong Cheng[SUP] 1 [/SUP], Nan Ye[SUP] 1 [/SUP], Lingqiang Kong[SUP] 1 [/SUP], Xiaoyi Zhao[SUP] 2 [/SUP], Hong Cheng[SUP] 1 [/SUP]
Affiliations
- PMID: 39534192
- PMCID: PMC11551107
- DOI: 10.1016/j.ekir.2024.08.006
Introduction: COVID-19 has been reported to be associated with the occurrence and recurrence of membranous nephropathy (MN). The clinicopathological characteristics and complement system activation of MN after COVID-19 are unclear.
Methods: A total of 38 patients with biopsy-proven MN who developed new-onset proteinuria after COVID-19 were enrolled in this study. One hundred patients with primary MN diagnosed before the COVID-19 pandemic were the control. Renal immunohistochemical staining for SARS-CoV-2 nucleocapsid protein was performed in 38 patients with MN after COVID-19. Serum membrane attack complex (MAC) was detected by enzyme-linked immunosorbent assay. Glomerular staining for the complement proteins in different pathways were detected by immunohistochemistry.
Results: Thirteen of 38 patients had positive staining for SARS-CoV-2 nucleocapsid protein. Compared with the control patients, the clinical manifestations were more severe in patients after COVID-19. Patients with positive SARS-CoV-2 staining had a higher proportion of nephrotic syndrome, lower level of serum albumin, and greater severity of renal interstitial fibrosis than those of patients with negative SARS-CoV-2 staining. Serum MAC level and renal MAC staining intensity of MN after COVID-19 were significantly higher than those of the control patients. MAC expression in MN patients with positive SARS-CoV-2 staining was stronger than that in both control patients and MN after COVID-19 with negative SARS-CoV-2 staining. The expression trend of factor H was consistent with that of MAC.
Conclusion: Excessive activation of the complement system aggravated symptoms in MN after COVID-19. Therapeutic strategy targeting the complement system may need to be considered.
Keywords: complement; coronavirus disease 2019; factor H; membranous nephropathy; severe acute respiratory syndrome corona virus 2; the alternative pathway.