Analysis of Clinical, Pathological and Prognostic Features of Coexistent Membranous and IgA Nephropathy in a Series of 13 Patients at a Tertiary Care Hospital

Abstract

BackgroundMembranous nephropathy (MN) and immunoglobulin A nephropathy (IgAN) are although two different entities, yet can rarely coexist. There is not much data available on this coexistent disorder, specifically with regard to the treatment modality and outcome. Here, we analyse in detail, retrospectively, 13 cases of coexistent IgA and membranous nephropathy (IgA-MN). MethodsRenal biopsy data of 1084 diagnosed cases of either membranous or IgA nephropathy was obtained from March 2015 till March 2021. Out of 1084 patients, 19 diagnosed cases of the coexistent disorder were identified. Six out of 19 patients were excluded because of their unwillingness. From remaining 13 patients, data regarding clinical presentation, investigations, management and treatment response was collected from hospital database, files and via telephonic interview. ResultsThe overall prevalence noted was 1.75%. Among them, 53.8% were females and 46.2% were males. Their median age was 40 years (range: 14-71 years). On workup, mean serum albumin was 2.64 g/dl (range: 1.6-3.8 g/dl), mean proteinuria was 5.5 g/24 hours (range: 1.55-11.48 g/24 hours) and mean creatinine was 0.98 mg/dl (range: 0.5-2.8 mg/dl). Anti-phospholipase A2 receptor antibody positivity was only 14.2%. The renal biopsy of all patients showed thickening of the glomerular basement membrane with granular IgG deposits and mesangial expansion with granular IgA deposits. A total of 80% patients showed complete remission with steroids, calcineurin inhibitors (CNIs) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs). ConclusionIgA-MN is probably a separate disorder that can only be confirmed on immunofluorescence microscopy. The response to the combination of steroids, CNIs and ACEi/ARBs is found to be the most effective; hence, this combination must often be used for the management of this coexistent disorder.

Glomerular Galactose-Deficient IgA1(KM55) Positive May Predict Poorer Prognosis in Coexisting Primary Membranous Nephropathy and IgA Nephropathy Patients

“…Our previous study reported that one third of patients who were PLA2R and THSD7A negative were NELL-1 positive [14]. In our study, patients with PMN/IgAN had a lower frequency of serum anti-PLA2R antibody and glomerular PLA2R positivity, consistent with other research findings [7,15]. Despite that the positive rates of glomerular PLA2R were lower in the PMN /IgAN group, glomerular IgG4 positive rates were similar.…”

“…There has been much controversy. Previous literature has reported that PMN and IgAN may occur in the same patient at an interval of several years [17,18] or on the occurrence of superimposed MN on a background of preexisting IgAN [7,19]. Conclusions are unclear.…”

“…The overall prevalence of this overlapping disorder was reported as about 1.47-1.75% [7,15]. Because of the low incidence, literature reports only a single case or case series of these PMN/IgAN patents.…”

“…With the intensive study of the pathogenic mechanism of PMN and IgAN, more and more evidence has indicated that PLA2R and Gd-IgA1 play important roles in PMN and IgAN separately. However, the clinicopathological characteristics and pathogenesis of these PMN/IgAN patients have been investigated only by single case or in case series [6,7]. The role of glomerular and serum Gd-IgA1 in these PMN/IgAN patients is rarely discussed.…”