Segmental glomerular necrosis as an active index of IgA nephropathy: A study with 100 serial sections of 128 cases

Abstract

One hundred serial sections from each of 128 cases with immunoglobulin A (IgA) nephropathy were examined by light microscopy to clarify the relationship between segmental glomerular necrosis (SGN) and progression of glornerular injury. The cases were divided into five groups according to the percentage of glomeruli with cellular/fibrocellular (C/F) crescents, fibrous adhesion and/or sclerosis: grade I, 0%; grade It, ~2 0 % ; grade 111, 20-50%; grade IV, 5040%; and grade V, 80% or more. The serial sections revealed unequivocally focal occurrence of SGN in 39 cases (30%). Segmental glomerular necrosis was never found in the cases of grade I (O%, 0/28), while it appeared in those of grade II (33%, 12/36), grade 111 (46%, 13/28), grade IV (48%, 13/27) and grade V (ll%, 1/9). The incidence of the cases with C/F crescents showed a similar tendency among the groups. In addition, focal C/F crescents were more frequent in cases with SGN (82%) than in those without SGN (24%). In particular, cellular crescents in 26 cases were formed in close proximity to SGN. These results suggested that SGN in IgA nephropathy was a more common finding than formerly evaluated and that it potentially participated in the progression of glomerular injuries closely associated with crescent formation. Unequivocally, focal occurrence of SGN corresponded well with the slowly progressive course of the glomerular disease.

Elevation of serum von Willebrand factor and anti‐endothelial cell antibodies in patients with immunoglobulin A nephropathy are associated with intrarenal arterial lesions

“…The clinical and pathological characteristics of patients with IgAN are diverse and vascular lesions are commonly found in renal biopsies. For example, it was reported that segmental necrotizing lesions of glomerular capillaries, similar to those of Henoch–Schonlein purpura and antineutrophil cytoplasmic antibody (ANCA)‐positive systemic vasculitis, could be found in 10–30% of patients with idiopathic IgAN 15,16 . An earlier study by Feiner et al.…”

Cellular Crescents and Segmental Glomerular Necrosis in IgA Nephropathy Are Indicative of the Beneficial Effects of Corticosteroid Therapy.

“…This study showeda more favorable response to PSLtherapy in cases with than in those without C/F crescents and/or SGN during the course of PSLtherapy. In our previous study using 100 serial sections of 128 cases with IgA nephropathy, SGNas well as C/F crescents occurred more frequently than suggested previously and we suggested that repeated occurrence of the lesions mayparticipate in slowly progressive deterioration of renal function (15). In this regard, IgA nephropathy may be considered slowly progressive crescentic glomerulonephritis.…”

Outcomes of IgA Nephropathy with Segmental Glomerular Necrosis But without Crescent Formation

“…SGN can be found in IgAN. Shouno et al [15] reported that the inci- [19] reported that the incidence of the segmental necrotizing lesion was 10.3%. In our center, we found that the incidence of segmental necrotizing lesion was 6.1%.…”

“…The pathological features have been proved as risk factors for progression of IgAN and were important factors for guiding treatment [5,6,21,22] . Most of the research found SGN accompanied by crescents were indicative of the beneficial effects of corticosteroid therapy [13][14][15] . In D'Amico's research, about IgAN with SGN, the effect of corticosteroid was not defined [21] .…”

“…But the significance of SGN was not included in all the classifications. Most of the researches about SGN in IgAN were about cellular crescents accompanied with SGN [13][14][15] . However, we have observed a number of patients who have presented with slight histopathological damage despite SGN.…”