Clinical significance of IgG deposition in the glomerular mesangial area in patients with IgA nephropathy

Wada, Yukihiro; Ogata, Hiroaki; Takeshige, Yui; Takeshima, Akiko; Yoshida, Noriyo; Yamamoto, Masahiro; Ito, Hidetoshi; Kinugasa, Eriko

doi:10.1007/s10157-012-0660-0

Cited by 44 publications

(59 citation statements)

References 18 publications

(21 reference statements)

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“…11 Recent observational studies have also indicated that the presence of mesangial IgG deposition had clinical significance in IgA nephropathy patients. 13,14 The present study clearly demonstrated that IgA nephropathy patients with glomerular IgG deposition had poorer long-term outcomes and the inclusion of glomerular IgG deposition evaluation in IgA nephropathy provided additional prognostic value in the adjusted model.…”

Section: Discussionsupporting

confidence: 52%

“…12 Moreover, recent observational studies have suggested that mesangial IgG deposition in IgA nephropathy could be associated with disease severity and renal progression. 13,14 The Oxford-MEST classification of IgA nephropathy identifies four types of lesions as specific pathological features that may act as independent predictors of clinical outcomes: mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T). 15,16 However, this new classification does not include immunofluorescence patterns, which might reflect the pathophysiological mechanisms active in IgA nephropathy.…”

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confidence: 99%

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Glomerular IgG deposition predicts renal outcome in patients with IgA nephropathy

et al. 2016

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Glomerular IgG deposition is frequently observed in patients with IgA nephropathy. However, the association between glomerular IgG deposition and progression of IgA nephropathy is uncertain. Six hundred and twentyseven patients with biopsy-proven IgA nephropathy were recruited. Histological variables of the Oxford classification (Oxford-MEST) and the presence of glomerular IgG deposits were assessed. Renal progression defined as end-stage renal disease or 50% reduction in estimated glomerular filtration rate was analyzed using Kaplan-Meier methods and Cox regression analysis. Of the study population, 200 patients (31.9%) had glomerular IgG deposition on immunofluorescence staining. During a mean follow-up of 56.8 ± 37.5 months, the rate of renal progression was significantly higher in the IgA nephropathy patients with glomerular IgG deposition compared with the IgA nephropathy patients without glomerular IgG deposition (39.8 vs 12.3 per 1000 patientyears; Po 0.001). Of patients with IgG deposition, 178 (28.3%), 20 (3.2%), and 2 (0.3%) patients had mild, moderate, and marked glomerular IgG deposits, receptively. Kaplan-Meier analysis revealed that cumulative renal survival was significantly lower in IgA nephropathy patients with the higher intensity of glomerular IgG deposits (Po 0.001). In addition, Cox regression analysis revealed that moderate and marked glomerular IgG deposits significantly predicted renal outcome independent of Oxford-MEST and clinical variables (HR, 2.97; 95% CI, 1.01-8.77; P = 0.04). This study showed that that glomerular IgG deposition was independently associated with poor renal outcome in patient with IgA nephropathy.

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Section: Discussionsupporting

confidence: 52%

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confidence: 99%

Glomerular IgG deposition predicts renal outcome in patients with IgA nephropathy

et al. 2016

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“…15,22 In a Japanese cohort, patients with glomerular IgG deposits had greater proteinuria at presentation and a lower rate of remission of urinary abnormalities after treatment than patients with IgA deposits alone. 23 Complement component 3 (C3) is present in >90% of biopsy samples, but typically C1q (the first subcom ponent of the C1 complex of the classical pathway of complement activation) is absent. The amount of mes angial C3 deposition might be of prognostic value; strong glomerular positivity for C3 on immunofluores cence and low levels of serum C3 were associated with loss of renal function in a report on IgA nephropathy from Korea.…”

Section: Immunohistology Of Iga Nephropathymentioning

confidence: 99%

Pathology of IgA nephropathy

2014

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IgA nephropathy is defined by the presence of IgA-dominant or co-dominant immune deposits within glomeruli. Biopsy specimens meeting these diagnostic criteria have a range of histological changes that are reflected in the variable clinical course of IgA nephropathy. The impact of histology on outcomes in IgA nephropathy has been clarified in a number of large retrospective clinicopathological studies. These studies have consistently demonstrated that the stage of disease at presentation, as indicated by the extent of interstitial fibrosis and tubular atrophy in the biopsy, is the strongest histological predictor of renal survival. The effect of active proliferative lesions on the disease course is less clear cut, owing in part to considerable treatment bias in most published retrospective studies. There is evidence that endocapillary hypercellularity and cellular crescents are responsive to immunosuppressive therapy, but this observation requires confirmation in prospective randomized controlled trials. Future challenges include improving the reproducibility of histological scoring, particularly for the presence and extent of endocapillary lesions, and to improve prognostic modelling by combining histological data with clinical variables and biomarker data.

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“…Many surveys of IgAN have been undertaken, with IgAN leading to ESRD in 30-40% of patients within 20 years after diagnosis 22) . In contrast to…”

Section: Discussionmentioning

confidence: 99%

Clinical and Histological Characteristics in Patients with Non-IgA Mesangioproliferative Glomerulonephritis

Hisada

Shimamoto

Ohsawa

et al. 2015

Juntendo Medical Journal

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Background: Mesangioproliferative glomerulonephritis is the most common type of chronic glomerulonephritis (CGN).However, the clinical characteristics and prognosis are not fully understood in patients without Immunoglobulin A (IgA) deposition. To explore the clinical and pathological characteristics of patients with mesangioproliferative glomerulonephritis without IgA deposition (N-IgAN), we performed dual retrospective analyses. Methods:A single-center study was performed in 60 patients with biopsy-proven N-IgAN. 98 age-and sex-matched IgA nephropathy (IgAN) patients were randomly selected as a control group. The clinical and histopathological data at the time of renal biopsy were compared between N-IgAN and IgAN. In a second study, the data for 477 patients who had undergone maintenance renal replacement therapy (RRT) was collected and examined for the causal primary diseases. Results: Duration from onset of renal symptoms to renal biopsy in patients with N-IgAN (71.2 ± 123.3 months) was significantly longer than that in patients with IgAN (65.9 ± 74.9 months) (p = 0.0328). Urinary protein excretion in N-IgAN patients (0.6 ± 1.1 g/gCr) was significantly lower than that in IgAN (1.0 ± 1.3 g/gCr) (p < 0.0001). Ratio of global sclerosis, segmental sclerosis, crescents, interstitial mononuclear cell infiltration, interstitial fibrosis, and tubular atrophy were significantly lower in N-IgAN patients. Of the 477 patients who had undergone maintenance RRT, 95 patients had CGN (19.9%). Among them, 37 patients had received a renal biopsy, only one patient was N-IgAN (1%). Conclusion:It appears that N-IgAN can be recognized as a benign disease entity in comparison with IgAN.

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Clinical significance of IgG deposition in the glomerular mesangial area in patients with IgA nephropathy

Cited by 44 publications

References 18 publications

Glomerular IgG deposition predicts renal outcome in patients with IgA nephropathy

Glomerular IgG deposition predicts renal outcome in patients with IgA nephropathy

Pathology of IgA nephropathy

Clinical and Histological Characteristics in Patients with Non-IgA Mesangioproliferative Glomerulonephritis

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