IgA nephropathy: Morphologic predictors of progressive renal disease (original) (raw)
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Clinical, histopathological and immunofluorescent findings of IgA Nephropathy
Background: IgA nephropathy, a prevalent disease in Asia, is considered the main cause of end stage renal disease among primary glomerular disease. Objective: To determine the frequency of different clinical, histopathological and immunofluorescent characteristics of IgA nephropathy. Methods: Renal biopsies of 376 patients were received for immunofluorescent and for histopathological studies. Biopsies were stained with fluorescene isothyocyanate (FITC) labeled antibodies against IgG, IgA, IgM, C3, C4 and fibrinogen for fluorescent microscopy. For histopathological examination, the specimens were stained with hematoxylin and eosin, periodic acid schiff and methanamine silver stains for light microscopy. Results: IgA nephropathy was diagnosed in 39 cases (10.4%) with a mean age 31.5 years and a male to female ratio of 2.8:1. The disease was observed in 11(29.7%) patients aged 21-30 years, followed by 8 patients (21.6%) aged 11-20 years group. Nephrotic range proteinuria was the most common laboratory finding which was detected in 11 patients (37%). Mesangioproliferative glomerulonephritis was the most common histopathological finding which was found in 7 patients (35%). IgA with other immunoglobulins and complements were deposited in 28 specimens (71.8%) as detected by immunofluorescence. Conclusion: IgA nephropathy is common in young people and one third of it results in end stage renal disease. We suggest that Immunofluorescent assay can be considered for the conclusive diagnosis of IgA nephropathy in young patients presenting with proteinuria/hematuria.
2015
Idiopathic IgA Nephropathy (IgAN) has been recognized as the most common form of glomerulonephritis worldwide since its original description by Berger and Hinglais. Initially considered as a benign disease, the natural history has changed considerably with studies showing an incidence of chronic renal failure ranging from 20 to 40%. The highly variable clinical course has resulted in efforts to determine clinical, laboratory, and histologic features that predict the development of renal failure in IgAN. Light microscopic appearances and clinical features can vary considerably, reflecting the many patterns of histopathologic injury seen. Closely associated with IgAN is Henoch – Schonlein purpura (HSP), a small vessel systemic vasculitis characterized by small blood vessel deposition of IgA predominantly affecting the skin, joints, gut, and kidney. The nephritis of HSP is also characterized by mesangial IgA deposition and may be histologically indistinguishable from IgAN. This article...
Characterization of early IgA nephropathy
American Journal of Kidney Diseases, 2000
Histological grading of 45 patients with clinical early immunoglobulin A (IgA) nephropathy was correlated with disease progression over a median follow-up of 123 months. Clinical early IgA nephropathy was defined as a serum creatinine level of 1.3 mg/dL or less, proteinuria of 0.4 g/d or less of protein, and the absence of hypertension at the time of renal biopsy. Disease progression was related to the occurrence of impaired renal function, increased proteinuria, and hypertension. We applied a previously described chronicity-based histological grading to the renal biopsy specimen and also assessed acute glomerular lesions. Disease progression was observed in 44.4% of these patients. Forty patients (89%) showed glomerular grade 1 (GG1) and 5 patients (11%) showed GG2, but this grading did not correlate with disease progression. However, when GG1 was subdivided into GG1a (mean sclerosis per glomerulus <10%) and GG1b (mean sclerosis per glomerulus 10% to <25%), GG1a correlated with nonprogressive disease. Tubulointerstitial grade also correlated with disease progression but was associated with a low sensitivity for predicting nonprogressive disease. Hyaline arteriolosclerosis and acute glomerular lesions did not correlate with disease progression. The chronicity-based histological grading is not only applicable to clinical early IgA nephropathy, but also more importantly, it characterizes GG1a in a subset of patients with a very low risk for disease progression, which can be regarded as genuine early IgA nephropathy.
The histopathological pattern of primary IgA nephropathy in a Malaysian patient population
The Malaysian journal of pathology, 1990
In the 10-year period from October 1977 to July 1987, 149 cases of primary IgA nephropathy were histologically confirmed through renal biopsies in the Department of Pathology, University Hospital, Kuala Lumpur. The ages of these patients ranged from 5 to 72 years, with the majority in the 20-30 year age group. There was no sex preponderance. The ethnic distribution showed a significant predominance of Chinese with 107 (71.8%) Chinese, 24 (16.1%) Malays, 15 (10.1%) Indians and 3 others. A wide range of renal glomerular pathology was seen, the commonest being diffuse mesangioproliferative glomerulonephritis (59.1%). Focal proliferative glomerulonephritis (14.1%) followed by minimal change glomerulonephritis (10.7%) were next in order of frequency. Immunofluorescence studies consistently demonstrated heavy and predominant IgA deposition in the mesangium. Weak deposition of C3, IgG and IgM were also observed in various combinations.
Journal of nephropathology, 2013
Implication for health policy/practice/research/medical education: Oxford classification of IgA nephropathy (IgAN) has been validated as clinically useful tool for prognostication of individual patients with IgAN. The original classification did not address the significance of immunostaining pattern in IgAN. A subsequent study by the same authors found immunostaining data to be potentially useful in predicting some of the morphological variables of Oxford classification. The study under discussion also addresses the potential significance of these ancillary data in refining the individual prognostication in this disease. Please cite this paper as: Mubarak M. Significance of immunohistochemical findings in Oxford classification of IgA nephropathy: The need for more validation studies. J Nephropathology. 2013; 2(3): 210-213. DOI: 10.5812/nephropathol.11089.
Outcome of IgA nephropathy in adults graded by chronic histological lesions
American Journal of Kidney Diseases, 2000
This prognostic study of primary immunoglobulin A (IgA) nephropathy focused on chronic irreversible glomerular sclerosis and interstitial fibrosis, based on the premise that this disease is characterized by a protracted and, for many, progressive course. We used a chronicity-based histological grading system to assess the biopsy specimens of 126 adults with IgA nephropathy over a median follow-up of 10 years. Our grading system included a glomerular grading (GG) of 1 to 3 based on the extent of glomerular sclerosis, a tubulointerstitial grading (TIG) of 1 to 3 based on the degree of tubular loss or interstitial fibrosis, and the evaluation of hyaline arteriolosclerosis (HA). These three histological parameters were correlated with each other and with serum creatinine level, degree of proteinuria, and blood pressure at the time of renal biopsy. Univariate analysis showed that these three histological and three clinical parameters were significantly correlated with renal survival. By multivariate analysis using the Cox regression model, GG, serum creatinine level, and degree of proteinuria represented independent prognostic factors of renal survival. For a subset of patients at a relatively early stage of disease with a serum creatinine level less than 130 µmol/L at the time of biopsy, all three histological features and degree of proteinuria were significantly correlated with renal survival, and GG was the only independent prognostic factor for renal outcome. This study shows that glomerular sclerosis represents the most important prognostic factor in adult patients with primary IgA nephropathy and has a strong predictive value. Our chronicity-based histological grading system not only correlates well with the natural history of IgA nephropathy but is also reproducible and relatively simple to apply. 2000 by the National Kidney Foundation, Inc.
IgA nephropathy: a clinicopathologic study from two centers in Saudi Arabia
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2010
A total of 42 patients, who were diagnosed to have primary Immunoglobulin A nephropathy (IgAN) at the King Abdul Aziz University Hospital and King Faisal Hospital, Jeddah over the last seven years, were studied. The objective was to analyze their clinical and pathological features and to classify them according to Hass Classification by using light, immunofluorescence and electron microscopy. Majority of the study cases were males in the second, third and fourth decades of life. Hematuria was the most common clinical complaint followed by proteinuria. There were varying degrees of mesangial proliferation. Majority of the cases presented with class-2 followed by class-3. Immunofluorescence demonstrated diffuse granular deposition of IgA in the glomerular mesangium in majority of the cases. Ultrastructural analysis showed electron dense deposits within the matrix of the mesangium and paramesangium in majority of the cases. Sub-endothelial deposits and mesangial interposition were demo...