Membranous Nephropathy with Solitary Immunoglobulin A Deposition

Kobayashi, Masaru; Usui, Joichi; Sakai, Kentaro; Mase, Kaori; Iwabuchi, Satoshi; Nagata, Michio; Kobayashi, Masaki; Yamagata, Kunihiro

doi:10.2169/internalmedicine.54.3655

Cited by 4 publications

(7 citation statements)

References 9 publications

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“…Therefore, pathological features in these two cases are not consistent with those of combined IgAN-MN. Table 1 summarizes clinicopathological findings in the previously reported case [6] and the present case. The patients were a 71-year-old Japanese female and a 60-year-old Japanese male.…”

Section: Discussionmentioning

confidence: 81%

“…To the best of our knowledge, only one case of solitary polyclonal IgA deposition was reported, namely by Kobayashi et al [6] in 2015. This patient and ours did not show mesangial IgA deposition, which is a characteristic finding of IgAN [10].…”

Section: Discussionmentioning

confidence: 99%

“…Biopsy findings that should prompt careful search for SMN include dominant depositions of IgG1/IgG3, IgA, IgM, or C1q, and electron-dense deposits in subendothelial or mesangial locations [1]. To our knowledge, there are several case reports of monoclonal IgA-type MN or IgA-type monoclonal immunoglobulin deposition disease (MIDD) with membranous features [3, 4, 5] and only one case report of MN with solitary polyclonal IgA deposition [6]. Here, we report an additional case of MN with solitary polyclonal IgA deposition.…”

Section: Introductionmentioning

confidence: 99%

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

Sawamura

Komatsuda

Kaga

et al. 2019

CNCS

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A 60-year-old man presented with nephrotic syndrome (NS). Light microscopy of renal biopsy specimens showed minor glomerular abnormalities, while immunofluorescence microscopy revealed solitary polyclonal granular IgA deposition along the glomerular capillary walls. Electron microscopy showed small amounts of electron-dense deposits in the subepithelial area, but not in the mesangial area. In this patient, apparent underlying disease was not found during the 3-year follow-up, and low-dose prednisolone was effective in the treatment of NS. To our knowledge, there is only one case report of membranous nephropathy with clinicopathological features similar to our case.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Sawamura

Komatsuda

Kaga

et al. 2019

CNCS

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“…Pathological results play decisive role in the diagnosis of nephropathy, by which kidney diseases are classified. Primary IgA nephropathy is characterized with IgA-dominant deposition in the glomerulus [ 12 ]; in MN, the pathological characteristics is IgG-dominant deposits [ 13 ] mostly with C3 deposits [ 14 ], and IgM or IgA has also been reported in MN [ 15 , 16 ]; normally, less immonoprotein depositions are found in the patients with MCD [ 17 ]; few researches find that IgA, IgM, C3 or C1q immune complex could also exist in MCD [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

A pilot and comparative study between pathological and serological levels of immunoglobulin and complement among three kinds of primary glomerulonephritis

et al. 2018

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BackgroundImmunoglobulin A nephropathy (IgAN), membranous nephropathy (MN) and minimal-change disease (MCD) are three common types of glomerulonephritis in China. Pathological diagnosis based on renal biopsy is the criterion and the golden standard for diagnosing the sub-types of primary or secondary glomerulonephritis. Immunoglobulin and complements might be used in the differential diagnosis of glomerulonephritis without renal biopsies. However, the relationship between IF intensities of immune proteins and the corresponding serum levels remained unclear, and seldom studies combine histopathological examination results and blood tests together for a predictive purpose. This study was considered as a pilot study for integrating histopathological indicators into serum parameters for exploring the relationship of IF intensity and serum values of immunoglobulin and complement, and for screening and investigating effective indicators inIgAN, MN and MCD.MethodsRenal tissue immunofluorescence (IF) intensity grades and serum levels of immunoglobulin and complements (IgG, IgA, IgM, C3 and C4) were retrospectively analyzed in 236 cases with IgAN, MN or MCD. IF grades were grouped as negative (−), positive (+) or strong positive (++) with both high and low magnification of microscope. Other serum indicators such as urea nitrogen (BUN), creatinine (Crea) and estimated glomerular filtration rate (eGFR) were also evaluated among the groups.ResultsThere were difference in IgA, IgG and C3 IF intensity grades among IgAN, MN and MCD groups (p = 9.82E-43, 4.60E-39, 7.45E-15, respectively). Serum values of BUN, Crea, eGFR, IgG, IgA, IgM and C4 showed difference in three groups (BUN: p = 0.045, Crea: p = 3.45E-5, eGFR: p = 0.005, IgG: p = 1.68E-14, IgA: p = 9.14E-9, IgM: p = 0.014, C4: p = 0.026). eGFR had the trend to decrease with enhanced IgA IF positive grades (p = 8.99E-4); Crea had trends to decrease with both enhanced IgA and IgG IF intensity grades (p = 2.06E-6, 2.94E-5, respectively). In all subjects, serum IgA levels was inversely correlated with eGFR(r = − 0.216, p = 0.001) and correlated with Crea levels(r = 0.189, p = 0.004); serum IgG and Crea showed no correlation which were discordance with inverse correlation of IgG IF grade and Crea(r = 0.058,p = 0.379). IgG serum level was inverse correlated with its IF grades (p = 3.54E-5, p = 7.08E-6, respectively); C3 serum levels had significantly difference between Neg and positive (+) group (p = 0.0003). IgA serum level was positive correlated with its IF grades (Neg-(+): p = 0.0001; (+)-(++): p = 0.022; Neg-(++): p = 2.01E-10). After matching comparison among C3 groups, C3 Neg. group and C3 ++ group had difference (*p = 0.017). C4 had all negative IF expression in all pathological groups. In IgAN subjects, there were statistical differences of serum C3 levels between its pathological Neg and positive (+) group(p = 0.026), and serum IgA levels showed difference between IgA pathological positive(+) and (++)(p = 0.007). In MN subjects, sIgG levels showed difference between Ig...

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“…Of note, only two cases of IMN with solitary polyclonal IgA deposition have been described previously, namely by Kobayashi et al (7) in 2015 and by Sawamura et al (8) in 2019. Table summarizes the clinicopathological findings in the previously reported cases and our present case.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Membranous Nephropathy with Solitary Immunoglobulin A Deposition: A Case Report and a Review of the Literature

Huang

Yang

et al. 2022

Intern. Med.

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A 63-year-old man with an 8-year history of proteinuria was diagnosed with nephrotic syndrome, and a renal biopsy was performed. Light and electron microscopic analyses showed classic features of idiopathic membranous nephropathy (IMN). However, immunofluorescence tests revealed solitary polyclonal granular IgA deposition along the glomerular capillary walls, rather than IgG, which is often dominant in IMN. The combined use of corticosteroids and calcineurin inhibitor was noticeably effective in reducing proteinuria and improving edema in the current case. Two additional rare cases of IMN with solitary IgA deposition were reviewed, and long-term surveillance is still warranted to characterize its clinicopathological features and outcome.

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Membranous Nephropathy with Solitary Immunoglobulin A Deposition

Cited by 4 publications

References 9 publications

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

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

A pilot and comparative study between pathological and serological levels of immunoglobulin and complement among three kinds of primary glomerulonephritis

Idiopathic Membranous Nephropathy with Solitary Immunoglobulin A Deposition: A Case Report and a Review of the Literature

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