Development of IgA nephropathy 14 years after diagnosis of membranous nephropathy

Miyazaki, Keiko; Miyazaki, Masanobu; Tsurutani, Hiroko; Sasaki, Osamu; Furusu, Akira; Taguchi, Takashi; Harada, Takashi; Ozono, Yoshiyuki; Kohno, Shigeru

doi:10.1093/ndt/17.1.140

Cited by 9 publications

(10 citation statements)

References 11 publications

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“…Miyazaki et al. [ 15 ] reported that IgAN developed 14 years after a diagnosis of MN. They postulated that discontinuation of immunosuppressive agents during the course of MN might enhance IgA synthesis and induce IgAN.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of patients with coexisting IgA nephropathy and membranous nephropathy

Chen

Shi

et al. 2018

Renal Failure

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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.

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Section: Discussionmentioning

confidence: 99%

Characteristics of patients with coexisting IgA nephropathy and membranous nephropathy

Chen

Shi

et al. 2018

Renal Failure

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“…Miyazaki et al . reported a case of the development of IgAN 14 years after the diagnosis of MN 22 . Genetic factors may contribute to the development of overlapping IgAN and MN.…”

Section: Discussionmentioning

confidence: 99%

Comparison of prognostic, clinical, and renal histopathological characteristics of overlapping idiopathic membranous nephropathy and IgA nephropathy versus idiopathic membranous nephropathy

Chen

Shi

et al. 2017

Sci Rep

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Overlapping idiopathic membranous nephropathy (IMN) and immunoglobulin A nephropathy (IgAN) is rare. This study aims to investigate the unique prognostic, clinical, and renal histopathological characteristics of IMN+IgAN. This retrospective observational study included 73 consecutive cases of IMN+IgAN and 425 cases of IMN treated between September 2006 and November 2015. Prognostic and baseline clinical and histopathological data were compared between the two patient groups. Poor prognostic events included a permanent 50% reduction in eGFR, end-stage renal disease, and all-cause mortality. Renal histopathology demonstrated that the patients with IMN+IgAN presented with significantly increased mesangial cell proliferation and matrix expansion, increased inflammatory cell infiltration, and higher proportions of arteriole hyalinosis and lesions than the patients with IMN (all P < 0.05). Kaplan–Meier analysis showed that the patients with IMN+IgAN had significantly higher cumulative incidence rates of partial or complete remission (PR or CR, P = 0.0085). Multivariate Cox model analysis revealed that old age at biopsy and high baseline serum creatinine and uric acid levels were significantly associated with poor prognosis (all P < 0.05), and increased IgA expression correlated significantly with PR or CR (P < 0.05). The present study found that overlapping IMN and IgAN presents with unique renal histopathology and appears not to cause a poorer prognosis than IMN.

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“…Although the prevalence of this coexistent disorder is rare, it is still necessary to create awareness among physicians to think about this possibility in case of an atypical presentation of patients [ 3 , 7 ]. Furthermore, it is not well known whether this overlapping disorder is a distinct clinicopathological entity or has progressed from one to the other disorder [ 7 , 10 ]. In addition to this, there is no published data that has specifically described about the effectiveness of a particular treatment modality for this coexistent disorder.…”

Section: Introductionmentioning

confidence: 99%

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

Saleem¹,

Bashir²,

Mahmud³

et al. 2021

Cureus

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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.

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Development of IgA nephropathy 14 years after diagnosis of membranous nephropathy

Cited by 9 publications

References 11 publications

Characteristics of patients with coexisting IgA nephropathy and membranous nephropathy

Characteristics of patients with coexisting IgA nephropathy and membranous nephropathy

Comparison of prognostic, clinical, and renal histopathological characteristics of overlapping idiopathic membranous nephropathy and IgA nephropathy versus idiopathic membranous nephropathy

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

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