Significance of IgA deposits location (mesangiocapillary versus pure mesangial) in IgA nephropathy and its association with morphologic variables of Oxford classification and various demographic data
Abstract
Introduction: IgA nephropathy is characterized by the presence of IgA-dominant glomerular deposits. Within this description, there is variation in the location of this immunoglobulin, from mesangial area to capillary walls. Objective: The aim of this study is to determine the potential correlation between the location of IgA deposits and morphologic variables of Oxford Classification (MEST) and various clinical data of patients with immunoglobulin A nephropathy (IgAN). Results: A total of 114 biopsies were enrolled to the study. Mean age of patients was 37.7 ± 13.6 years. Patients were divided into two groups of pure mesagnial and mesangiocapillary deposits. In this study 10.5 percent of renal biopsies had mesangial-capillary IgA deposits. There was not significant association of proportion of totally sclerosed glomeruli, extracapillary, proliferation, percentage of peri-glomerular fibrosis, thickening of the Bowman’s capsule, percent of interstitial fibrosis, mesangial proliferation in any degree and mesangial widening with pure mesangial or mesangial-capillary deposits (p>0.05). There was not significant association of age, serum creatinine and levels of proteinuria with pure mesangial or mesangiocapillary deposits (p>0.05).Among four morphologic variables of Oxford classification only E variable (endocapillary proliferation) had significant association with mesangiocapillary deposits (P=0.04). Conclusions: The association of mesangiocapillary IgA deposits with endocapillary proliferation may imply the severity of the disease. We recommend that the location and intensity of IgA is routinely included in the renal biopsy report.
References
Nasri H, Mortazavi M, Ghorbani A, Shahbazian H, Kheiri S, Baradaran A, et al. Oxford-MEST classification in IgA nephropathy patients: A report from Iran. J Nephropathol. 2012;1(1):31-42.
Nasri H. Comment on: Clinical, Histopathological and Immunofluorescent Findings of IgA Nephropathy and author’s reply. Iran J Immunol. 2012;9(4):266-7.
Vanikar A. IgM nephropathy; can we still ignore it. J Nephropathol. 2013;2(2):98-103.
Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Roberts IS, Cook HT, Troyanov S, Alpers CE, Amore A, et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int. 2009;76(5):546-56.
Mubarak M. Oxford classification of IgA nephropathy: Broadening the scope of the classification. J Nephropathology. 2012;1(1):13-6.
Bellur SS, Troyanov S, Cook HT, Roberts IS; Working Group of International IgA Nephropathy Network and Renal Pathology Society. Immunostaining findings in IgA nephropathy: correlation with histology and clinical outcome in the Oxford classification patient cohort. Nephrol Dial Transplant. 2011;26(8):2533-6.
Assadi F. The epidemic of pediatric chronic kidney disease: the danger of skepticism. J Nephropathology. 2012;1(2):61-4.
Gheissari A, Hemmatzadeh S, Merrikhi A, Fadaei Tehrani S, Madihi Y. Chronic kidney disease in children: A report from a tertiary care center over 11 years. J Nephropathol. 2012;1(3):177-82.
Kam Tao Li P, Burdmann EA, Mehta RL; World Kidney Day Steering Committee 2013. Acute kidney injury: Global health alert. J Nephropathol. 2013;2(2):90-7.
Gheissari A, Mehrasa P, Merrikhi A, Madihi Y. Acute kidney injury: A pediatric experience over 10 years at a tertiary care center. J Nephropathol. 2012;1(2):101-8.
Kari J. Epidemiology of chronic kidney disease in children. J Nephropathology. 2012;1(3):162-3.
Seif EI, Ibrahim EA, Elhefnawy NG, Salman MI. Histological patterns of idiopathic steroid resistant nephrotic syndrome in Egyptian children: A single centre study. J Nephropathology. 2013;2(1):53-60.
D'Amico G. The commonest glomerulonephritis in the world: IgA nephropathy. Q J Med. 1987;64(245):709-27.
Shakeel Sh, Mubarak M, Kazi JI, Jafry N, Ahmed E. Frequency and clinicopathological characteristics of variants of primary focal segmental glomerulosclerosis in adults presenting with nephrotic syndrome. J Nephropathology. 2013;2(1):28-35.
Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Cattran DC, Coppo R, Cook HT, Feehally J, Roberts IS, et al. The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int. 2009;76(5):534-45.
Bellur SS, Troyanov S, Cook HT, Roberts IS; Working Group of International IgA Nephropathy Network and Renal Pathology Society. Immunostaining findings in IgA nephropathy: correlation with histology and clinical outcome in the Oxford classification patient cohort. Nephrol Dial Transplant. 2011;26(8):2533-6.
Mubarak M, Kazi JI, Kulsoom U, Ishaque M. Detection of immunoglobulins and complement components in formalin fixed and paraffin embedded renal biopsy material by immunoflourescence technique. J Nephropathology. 2012;1(2):91-100.
Mortazavi M, Nasri H. Granulomatosis with polyangiitis (Wegener’s) presenting as the right ventricular masses: A case report and review of the literature. J Nephropathology. 2012;1(1):49-56.
Berger J, Hinglais N. Intercapillary deposits of IgA-IgG. J Urol Nephrol (Paris). 1968;74(9):694-5.
Andreoli SP, Yum MN, Bergstein JM. IgA nephropathy in children: significance of glomerular basement membrane deposition of IgA. Am J Nephrol. 1986;6(1):28-33.
Abuelo JG, Esparza AR, Matarese RA, Endreny RG, Carvalho JS, Allegra SR. Crescentic IgA nephropathy. Medicine (Baltimore). 1984;63(6):396-406.
Yoshimura M, Kida H, Abe T, Takeda S, Katagiri M, Hattori N. Significance of IgA deposits on the glomerular capillary walls in IgA nephropathy. Am J Kidney Dis. 1987;9(5):404-9.
Andreoli SP, Yum MN, Bergstein JM. IgA nephropathy in children: significance of glomerular basement membrane deposition of IgA. Am J Nephrol. 1986;6(1):28-33.
Barbour SJ, Reich HN. Risk stratification of patients with IgA nephropathy. Am J Kidney Dis. 2012;59(6):865-73.
Nasri H. Hypertension and renal failure with right arm pulse weakness in a 65 years old man. J Nephropathology. 2012;1(3):130-3.
Torbati PM. Focal segmental glomerulosclerosis; collapsing variant. J Nephropathology. 2012;1(2):87-90.
Galesic K, Ljubanovic D, Horvatic I. Tratment of renal manifestations of ANCA-associated Vasculitis. J Nephropathology. 2013;2(1):6-19.
Tayebi Khosroshahi H. Short history about renal transplantation program in Iran and the world: Special focus on world kidney day. J Nephropathology. 2012;1(1)5-10.
Mubarak M. Collapsing focal segmental glomerulosclerosis: increasing the awareness. J Nephropathology. 2012;1(2):77-80.
Wang T, Ye F, Meng H, Zhang L, Jin X. Comparison of clinicopathological features between children and adults with IgA nephropathy. Pediatr Nephrol. 2012;27(8):1293-300.