Glomerular IgG deposition predicts renal outcome in patients with IgA nephropathy

Abstract

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.

Severity of foot process effacement is associated with proteinuria in patients with IgA nephropathy

“…Second, the severity of FPE was determined by visual inspection in a semi-quantitative fashion. Third, the proportion of IgG deposits in our cohort was smaller (28 cases, 10.4%) compared to previous reports [34][35][36]. These results might be affected by a regional determinant of renal biopsies, such as medical insurance or tests for mandatory military service.…”

Inflammatory and Humoral Immune Status in Chronic Kidney Disease

“…As seen in Table 1, median (IQR) values of Blood urea (mg/dL) in CKD patients and controls were 95 (66-122)and 20 (16)(17)(18)(19)(20)(21)(22)(23) respectively which was significantly high in CKD (p <0.0001) compared to controls. Similarly creatinine also showed significant increase in CKD patients.…”

“…In addition, glomerular IgG deposition correlated with greater histological activity and increased clinical severity suggesting that these depositions may have a role in the progression of CKD. 19 The deposition of Immunoglobulins G, M, A, C3, and C4 together with C1q is the hallmark of lupus nephritis and is stated to as the 'full house pattern' of immune deposition. 20 This pattern of deposition in kidneys may mark the decrease of immunoglobulin levels in most of these patients.…”

Rectal Adenocarcinoma As An Uncommon Cause of Immunoglobulin A Vasculitis (Henoch-Schönlein Purpura)

“…7 Renal biopsy may vary from mild mesangial expansion to the more serious necrotizing glomerulonephritis, which is mainly of IgA deposition. 8 Signs in the renal biopsy of IgA vasculitis are the same as those of IgA nephritis. 9 The etiology of IgA vasculitis is yet to be determined; however, there are often precipitating factors, such as infectious diseases, a reaction to drugs or malignancy.…”