The source of IgA and the mechanism for deposition of IgA in the mesangium remain unknown for primary IgA nephropathy. Because CD19 ϩ
CD5ϩ B cells are important producers of IgA and contribute to several autoimmune diseases, they may play an important role in IgA nephropathy. In this study, flow cytometry, quantitative PCR, and confocal microscopy were used to assess the frequency, distribution, Ig production, CD phenotypes, cytokine production, and sensitivity to apoptosis of CD19 In the three patients who had IgA nephropathy and did not respond to treatment, the frequency of CD19 ϩ CD5 ϩ B cells did not change. CD19 ϩ CD5 ϩ B cells isolated from patients with untreated IgA nephropathy expressed higher levels of IgA, produced more IFN-␥, and were more resistant to CD95L-induced apoptosis than cells isolated from control subjects and patients with lupus; these properties reversed with effective treatment of IgA nephropathy. In conclusion, these results strongly suggest that CD19 ϩ CD5 ϩ B cells play a prominent role in the pathogenesis of primary IgA nephropathy.