Morphologic High-Risk Factors in IgA Nephropathy

Abstract

Aim: Morphologic risk factors for developing end-stage renal failure (ESRD) due to IgA nephropathy may be difficult to identify in populations where the course is benign in the vast majority. Ours is a high-risk population. Methods: Protocols of 67 biopsies from native kidneys of kidney transplant patients with IgA nephropathy were reevaluated with respect to the prevalence of certain structural findings. Time points for onset of symptoms, biopsy procedure, and ESRD were recorded. Results: Features seen with more than expected frequency were: extracapillary proliferation in 49%, cellular infiltrates in the interstitium in 89%, marked tubular atrophy in 54%, and IgA deposits in the peripheral capillary loops in 71%. With extracapillary proliferation the remaining time to ESRD was 3.5 ± 3.2 versus 7.0 ± 4.2 years without (p < 0.0004). With marked tubular atrophy the remaining time was 3.5 ± 2.7 and 8.2 ± 4.2 years without (p = 0.0002). Cellular infiltrates in the interstitium also signified shorter progression (p = 0.009). Except for the presence of IgA in the periphery, no finding by immune fluorescence was more frequent than expected or correlated with progression. Conclusion: Extracapillary proliferation, interstitial cellular infiltrates, marked tubular atrophy, and IgA deposits in the peripheral capillary loops indicate risk of progressive renal failure in IgA nephropathy, but other findings by immune fluorescence do not.

Upregulation of cyclooxygenase-1 and the PGE2 receptor EP2 in rat and human mesangioproliferative glomerulonephritis

“…Expression of Cox-2 immunoreactivity was observed in interstitial infiltrates in all biopsies from patients with IgA nephritis. Interstitial cellular infiltration is a common feature of IgA nephropathy and seems to relate to the risk of chronic renal failure [58]. Infiltrates consist of cells of the monocytic and lymphocytic cell lineage.…”

Evaluation of Clinical and Pathological Characteristics of Patients with IgA Nephropathy Based on Oxford Classification System: Should Crescents be Included?

“…Tubular atrophy-interstitial fibrosis and crescent have been underlined as independent predictors of end-points. There are many studies supporting crescent formations to be poor prognostic factors [20][21][22][23]. In the present study, definite findings about poor clinical course are an important step in revealing that classification system should be re-evaluated in terms of crescent formations.…”

Increased Prevalence of Anti-Gliadin IgA-Antibodies with Aberrant Duodenal Histopathological Findings in Patients with IgA-Nephropathy and Related Disorders

“…The finding of elevated IgA-AGA levels in 13 patients with other diagnoses (three with IgAN secondary to HSP, three with suspected IgAN, moreover one patient with a possible late IgAN but with a light microscopic picture of glomerulosclerosis plus six other patients) may well suggest that some of them indeed had a late IgAN. This can be difficult to detect due to the presence of nephrosclerosis or glomerulosclerosis in the kidney biopsy (32). It may be due to the presence of elevated S-IgA levels, possibly affecting the frequency of positive IgA-AGA.…”