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Diagnosis: IgA Nephropathy (with subendothelial deposits and IgG co-deposition)
The development of immunoglobulin A (IgA) nephropathy (IgAN) appears to require an autoantibody (IgG or IgA) against the autoantigen galactose-deficient IgA1. Pathologically, IgAN is an IgA dominant or codominant immune complex–mediated glomerulonephritis that may have codeposition of IgG by immunofluorescence.
In a multicenter IgAN cohort, IgG co-deposition and location of glomerular immune deposits in the peripheral capillary walls (PCWs) were both associated with greater histologic activity on renal biopsy, but only the location of glomerular immune deposits was significantly associated with definitive renal outcomes. Patients with immune deposits in the PCWs in addition to the mesangium had greater proteinuria at diagnosis and were at increased risk for ESRD, transplant, death and/or doubling of SCr (Alvarado AS, et al. Location of glomerular immune deposits, not codeposition of immunoglobulin G, influences definitive renal outcomes in immunoglobulin A nephropathy. Nephrol Dial Transplant. 2018 Jul 1;33(7):1168-1175. [PubMed link])
See the chapter: IgA Nephropathy of our Tutorial.
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References
- Alvarado AS, Andeen NK, Brodsky S, Hinton A, Nadasdy T, Alpers CE, Blosser C, Najafian B, Rovin BH. Location of glomerular immune deposits, not codeposition of immunoglobulin G, influences definitive renal outcomes in immunoglobulin A nephropathy. Nephrol Dial Transplant. 2018;33(7):1168-1175. [PubMed link]
- Takada D, Sumida K, Sekine A, Hazue R, Yamanouchi M, Suwabe T, Hayami N, Hoshino J, Sawa N, Takaichi K, Fujii T, Ohashi K, Ubara Y. IgA nephropathy featuring massive wire loop-like deposits in two patients with alcoholic cirrhosis. BMC Nephrol. 2017;18(1):362. [PubMed link]
- Yamaji K, Suzuki Y, Suzuki H, Satake K, Horikoshi S, Novak J, Tomino Y. The kinetics of glomerular deposition of nephritogenic IgA. PLoS One. 2014 Nov 19;9(11):e113005. [PubM ed link]
- Kurosu A, Oka N, Hamaguchi T, Yoshikawa N, Joh K. Infantile immunoglobulin A nephropathy showing features of membranoproliferative glomerulonephritis. Tohoku J Exp Med. 2012;228(3):253-8. [PubMed link]