Characteristics of patients with coexisting IgA nephropathy and membranous nephropathy

Abstract

Background: Coexistence of IgA nephropathy (IgAN) and membranous nephropathy (MN) in the same patient is rare. Few studies have reported the clinical and pathological features of patients with combined IgAN and MN (IgAN–MN).Methods: The clinico-pathological features, levels of galactose-deficient IgA1 (Gd-IgA1) and autoantibodies against M-type transmembrane phospholipase A2 receptor (anti-PLA2R) in sera were compared among IgAN–MN, IgAN, and MN patients.Results: Twenty-six patients with biopsy-proven IgAN–MN were enrolled. The mean age at biopsy was 43.6 ± 15.9 years, and 65.4% were male. Proteinuria and estimated glomerular filtration rate (eGFR) levels in patients with IgAN–MN were similar to that of MN patients. Compared with the IgAN patients, IgAN–MN patients showed a higher median proteinuria level (4.3 vs. 1.2 g/day, p < .001), and a higher mean eGFR level (101.8 ± 25.4 vs. 78.6 ± 26.9 mL/min/1.73 m2, p < .001). IgAN–MN patients presented with milder pathological lesions than IgAN patients according to the Oxford Classification. IgAN–MN patients had comparable serum levels of Gd-IgA1 with those of IgAN patients (353.4 ± 95.5 vs. 347.0 ± 109.6 U/mL, p = .801). Percentage of IgAN–MN patients with detectable serum levels of anti-PLA2R was lower than that of MN patients (38.5% vs. 68.6%, p = .011).Conclusions: IgAN–MN patients display similar clinical features to MN patients and milder pathological lesions than IgAN patients. IgAN–MN patients have similar levels of Gd-IgA1 to those of IgAN patients, and a lower proportion of anti-PLA2R than MN patients.

Membranous nephropathy with solitary polyclonal IgA deposition: A case report and literature review

“…They speculated that the occurrence of superimposed MN combined with a background of preexisting IgAN causes combined IgAN-MN. However, this entity is different from our case, because it has capillary wall IgG immune deposits combined with mesangial IgA-dominant deposits [9].…”

“…Coexistence of IgA nephropathy (IgAN) and MN is rarely seen in the same patient. In Chen et al’s [9] series of IgAN, 26 out of 3,543 patients (0.7%) had combined IgAN-MN. Mesangial expansion and mesangial hypercellularity, which are characteristic findings of IgAN [10], were observed in all these patients.…”

Double Glomerulonephritis in a Patient with Ankylosing Spondylitis Treated with Biologic Agent: Extrarticolar Involvement or Anti-Tumor Necrosis Factor Alpha Injury? A Case-Based Review

“…In a recent series of 9 patients, only 38% of patient had positivity of Ab Anti-PLA2R thus supporting the hypotesis of another possible pathogenetic mechanism. 13 As discussed earlier, there are growing evidences of possible renal damage related to Anti-TNF even in the form of glomerulonephritis. In this regard only one case of membranous nephropathy associated to Adalimumab 15 was reported as well as one case of IgA nephropathy with the same drug.…”

“…2 Irrespective of any rheumatological pathology in the general population there are few cases in literature of Membranous nephropathy concomitant with IgA nephropaty,. 12,13 As mentioned in the past by Kobayashi et al, 14 IgA-GNM should be considered as a separate entity but this definition is still debated. In a recent series of 9 patients, only 38% of patient had positivity of Ab Anti-PLA2R thus supporting the hypotesis of another possible pathogenetic mechanism.…”

Clinicopathological analysis of IgA nephropathy combined with other glomerular diseases

“…There have been a few reports of the concurrence of IgAN and MN. [7–9] Some speculated that the combination was caused by the occurrence of superimposed MN on a background of preexisting mild IgAN. Others took it as a unique entity rather than due to chance alone.…”