C4D在肾脏疾病中的研究进展
C4D and Primary Glomerular Diseases
DOI: 10.12677/jcpm.2025.43389, PDF,   
作者: 宗子寒, 臧瑞先, 孙楠楠, 孙 鹏, 季文涛：山东第一医科大学(山东省科学院)临床医学院，山东 济南；孙书珍*：山东第一医科大学附属省立医院小儿肾脏风湿免疫科，山东 济南
关键词: C4D；原发性肾小球疾病；肾组织病理；补体系统；C4D； Primary Glomerular Diseases； Renal Histopathology； Complement System
摘要: 补体级联是一种蛋白质系统，其主要作用是启动和调节免疫反应。在补体激活过程中，循环蛋白被切割，新生切割片段参与广泛的下游先天和适应性免疫功能。尽管这些功能中的大多数是稳态的或保护性的，但是大量的实验和临床证据也强调了补体系统在许多类型的肾小球疾病的发病机理中的中心作用。本综述旨在总结现有的关于不同肾小球疾病的肾活检肾小球C4D沉积的数据，这些数据可能有助于进一步研究补体激活在肾小球疾病中的作用。
Abstract: The complement cascade is a protein system whose main role is to initiate and regulate the immune response. During the process of complement activation, circulating proteins are cleaved, and the newly generated cleavage fragments are involved in a wide range of downstream innate and adaptive immune functions. Although most of these functions are homeostatic or protective, a large amount of experimental and clinical evidence also highlights the central role of the complement system in the pathogenesis of many types of glomerular diseases. This review aims to summarize the existing data on glomerular C4D deposition in native renal biopsies of different glomerular diseases, and these data may contribute to further research on the role of complement activation in glomerular diseases.
文章引用：宗子寒, 臧瑞先, 孙楠楠, 孙鹏, 季文涛, 孙书珍. C4D在肾脏疾病中的研究进展[J]. 临床个性化医学, 2025, 4(3): 628-634. https://doi.org/10.12677/jcpm.2025.43389

参考文献

[1] Mathern, D.R. and Heeger, P.S. (2015) Molecules Great and Small: The Complement System. Clinical Journal of the American Society of Nephrology, 10, 1636-1650. [Google Scholar] [CrossRef] [PubMed]
[2] Thurman, J.M. and Nester, C.M. (2016) All Things Complement. Clinical Journal of the American Society of Nephrology, 11, 1856-1866. [Google Scholar] [CrossRef] [PubMed]
[3] Chandra, P. (2019) C4D in Native Glomerular Diseases. American Journal of Nephrology, 49, 81-92. [Google Scholar] [CrossRef] [PubMed]
[4] Ichida, S., Yuzawa, Y., Okada, H., Yoshioka, K. and Matsuo, S. (1994) Localization of the Complement Regulatory Proteins in the Normal Human Kidney. Kidney International, 46, 89-96. [Google Scholar] [CrossRef] [PubMed]
[5] Sethi, S., Nasr, S.H., De Vriese, A.S. and Fervenza, F.C. (2015) C4D as a Diagnostic Tool in Proliferative GN. Journal of the American Society of Nephrology, 26, 2852-2859. [Google Scholar] [CrossRef] [PubMed]
[6] Custódio, F.B., Silva, C.A.D., Helmo, F.R., Machado, J.R. and Reis, M.A.D. (2017) Complement System and C4D Expression in Cases of Membranous Nephropathy. Brazilian Journal of Nephrology (BJN), 39, 370-375. [Google Scholar] [CrossRef] [PubMed]
[7] Paunas, T.I.F., Finne, K., Leh, S., Marti, H.P., Mollnes, T.E., Berven, F. and Vikse, B.E. (2017) Glomerular Abundance of Complement Proteins Characterized by Proteomic Analysis of Laser-Captured Microdissected Glomeruli Associates with Progressive Disease in IgA Nephropathy. Clinical Proteomics, 14, Article No. 30. [Google Scholar] [CrossRef] [PubMed]
[8] Hiemstra, P.S., Gorter, A., Stuurman, M.E., Van Es, L.A. and Daha, M.R. (1987) Activation of the Alternative Pathway of Complement by Human Serum Iga. European Journal of Immunology, 17, 321-326. [Google Scholar] [CrossRef] [PubMed]
[9] Wu, D., Lei, L., Zhang, H., Yao, X., Chen, Z., Zhang, N., et al. (2022) Clinical Relevance of Glomerular C4D Deposition in Children with Early IgA Nephropathy or Henoch-Schönlein Purpura Nephropathy. Pediatric Nephrology, 38, 431-438. [Google Scholar] [CrossRef] [PubMed]
[10] Bogers, W.M.J.M., Stad, R., van Es, L.A. and Daha, M.R. (1991) Immunoglobulin A: Interaction with Complement, Phagocytic Cells and Endothelial Cells. Complement and Inflammation, 8, 347-358. [Google Scholar] [CrossRef] [PubMed]
[11] Zhou, W., Wang, H., Sun, S., Shen, Y., Liu, X., Zhen, J., et al. (2022) Association between Glomerular C4D Deposition, Proteinuria, and Disease Severity in Children with IgA Nephropathy. Pediatric Nephrology, 38, 1147-1157. [Google Scholar] [CrossRef] [PubMed]
[12] Roos, A., Bouwman, L.H., van Gijlswijk-Janssen, D.J., Faber-Krol, M.C., Stahl, G.L. and Daha, M.R. (2001) Human IgA Activates the Complement System via the Mannan-Binding Lectin Pathway. Journal of Immunology, 167, 2861-2868. [Google Scholar] [CrossRef] [PubMed]
[13] Qin, S., Wang, X., Wang, J. and Wu, H. (2024) Complement C4D as a Biomarker for Systemic Lupus Erythematosus and Lupus Nephritis. Lupus, 33, 111-120. [Google Scholar] [CrossRef] [PubMed]
[14] Troldborg, A., Thiel, S., Trendelenburg, M., Friebus-Kardash, J., Nehring, J., Steffensen, R., et al. (2018) The Lectin Pathway of Complement Activation in Patients with Systemic Lupus Erythematosus. The Journal of Rheumatology, 45, 1136-1144. [Google Scholar] [CrossRef] [PubMed]
[15] Martin, M., Trattner, R., Nilsson, S.C., Björk, A., Zickert, A., Blom, A.M. and Gunnarsson, I. (2020) Plasma C4D Correlates with C4D Deposition in Kidneys and with Treatment Response in Lupus Nephritis Patients. Frontiers in Immunology, 11, Article 582737. [Google Scholar] [CrossRef] [PubMed]
[16] Yang, X., Yuan, Y., Shao, X., Pang, H., Che, X., Cao, L., et al. (2022) C4D as a Screening Tool and an Independent Predictor of Clinical Outcomes in Lupus Nephritis and Iga Nephropathy. Frontiers in Medicine, 9, Article 832998. [Google Scholar] [CrossRef] [PubMed]
[17] Mejía-Vilet, J.M., Córdova-Sánchez, B.M., Arreola-Guerra, J.M., Morales-Buenrostro, L.E., Uribe-Uribe, N.O. and Correa-Rotter, R. (2015) Renal Flare Prediction and Prognosis in Lupus Nephritis Hispanic Patients. Lupus, 25, 315-324. [Google Scholar] [CrossRef] [PubMed]
[18] Li, S., Liu, Z., Zen, C., Wang, Q., Wang, Y. and Li, L. (2007) Peritubular Capillary C4D Deposition in Lupus Nephritis Different from Antibody-Mediated Renal Rejection. Lupus, 16, 875-880. [Google Scholar] [CrossRef] [PubMed]
[19] Wang, X., Fu, S., Yu, J., Tang, D., Wu, H. and Xu, Z. (2023) Renal C4D Is a Potential Biomarker of Disease Activity and Severity in Pediatric Lupus Nephritis Patients. Frontiers in Pediatrics, 11, Article 1193917. [Google Scholar] [CrossRef] [PubMed]
[20] Bally, S., Debiec, H., Ponard, D., Dijoud, F., Rendu, J., Fauré, J., et al. (2016) Phospholipase A2 Receptor-Related Membranous Nephropathy and Mannan-Binding Lectin Deficiency. Journal of the American Society of Nephrology, 27, 3539-3544. [Google Scholar] [CrossRef] [PubMed]
[21] Srinivas, B.H., Stephen, N. and Ps, P. (2023) Diagnostic Utility of C4D Immunohistochemistry in Membranous Nephropathy. International Journal of Clinical and Experimental Pathology, 16, 94-98.
[22] Drachenberg, C.B., Papadimitriou, J.C., Chandra, P., Haririan, A., Mendley, S., Weir, M.R., et al. (2019) Epidemiology and Pathophysiology of Glomerular C4D Staining in Native Kidney Biopsies. Kidney International Reports, 4, 1555-1567. [Google Scholar] [CrossRef] [PubMed]
[23] Espinosa-Hernández, M., Ortega-Salas, R., López-Andreu, M., Gómez-Carrasco, J.M., Pérez-Sáez, M.J., Pérez-Seoane, C. and Aljama-García, P. (2012) C4D as a Diagnostic Tool in Membranous Nephropathy. Nefrologia, 32, 295-299.
[24] Pradeep, I. and Srinivas, B.H. (2023) Utility of C4D Immunohistochemistry as an Adjunct Stain in Diagnostic Renal Pathology of Glomerular Diseases. International Journal of Surgical Pathology, 32, 21-26. [Google Scholar] [CrossRef] [PubMed]
[25] Val-Bernal, J.F., Garijo, M.F., Val, D., Rodrigo, E. and Arias, M. (2011) C4D Immunohistochemical Staining Is a Sensitive Method to Confirm Immunoreactant Deposition in Formalin-Fixed Paraffin-Embedded Tissue in Membranous Glomerulonephritis. Histology and Histopathology, 26, 1391-1397.
[26] Fakhouri, F., Frémeaux-Bacchi, V., Noël, L.H., Cook, H.T. and Pickering, M.C. (2010) C3 Glomerulopathy: A New Classification. Nature Reviews Nephrology, 6, 494-499. [Google Scholar] [CrossRef] [PubMed]
[27] Pickering, M.C., D’Agati, V.D. and Nester, C.M. (2013) C3 Glomerulopathy: Consensus Report. Kidney International, 84, 1079-1089.
[28] Gupta, N., Wakefield, D.N., Clapp, W.L. and Garin, E.H. (2017) Use of C4D as a Diagnostic Tool to Classify Membranoproliferative Glomerulonephritis. Nefrología (English Edition), 37, 78-86. [Google Scholar] [CrossRef] 
[29] Hresko, S., Madarova, M., Dobosova, M., Palusekova, N., Niznerova, P., Ziaran, S., et al. (2024) The Diagnostic Significance of C4D Deposits, as an Immunohistochemical Proof of Complement Activation, in Kidney Glomerular Pathologies and Kidney Transplantation. Bratislava Medical Journal, 125, 275-280. [Google Scholar] [CrossRef] [PubMed]
[30] Jankauskiene, A., Jakutovic, M., Cerniauskiene, V. and Malikenas, A. (2003) Echocardiographic Findings in Children Ill with Acute Postinfectious Glomerulonephritis. European Journal of Pediatrics, 162, 500-505. [Google Scholar] [CrossRef] [PubMed]
[31] Brant Pinheiro, S.V., de Freitas, V.B., de Castro, G.V., Rufino Madeiro, B.C., de Araújo, S.A., Silva Ribeiro, T.F., et al. (2022) Acute Post-Streptococcal Glomerulonephritis in Children: A Comprehensive Review. Current Medicinal Chemistry, 29, 5543-5559. [Google Scholar] [CrossRef] [PubMed]
[32] Wyatt, R.J., Forristal, J., West, C.D., Sugimoto, S. and Curd, J.G. (1988) Complement Profiles in Acute Post-Streptococcal Glomerulonephritis. Pediatric Nephrology, 2, 219-223. [Google Scholar] [CrossRef] [PubMed]
[33] Dhakal, A.K., Shrestha, D., KC, D. and Yadav, S.P. (2025) A Narrative Review of Acute Post-Streptococcal Glomerulonephritis in Nepali Children. BMC Nephrology, 26, Article No. 142. [Google Scholar] [CrossRef] [PubMed]