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Diagnosis: IgA Nephropathy (with subendothelial deposits)
Although it is a frequent diagnosis in kidney biopsy, several things make this case very interesting. First, there is an acute clinical presentation, only 1 month of symptoms, however, we already see chronic changes in the biopsy, this is somewhat frequent in the disease, possibly years of asymptomatic evolution and it only manifests when there are chronic changes or more severe acute alterations.
Secondly, the necrotizing lesion evidenced in a glomerulus (Figure 4), a lesion that suggests a more aggressive presentation and that may imply a worse prognosis. The presence of segmental glomerular sclerosing lesions also implies a worse prognosis, something that has been known for several decades and is reflected in the Oxford classification.
And thirdly, the presence of subendothelial deposits, which are insinuated in the IF images and confirmed with the ME, accompanied by double contours (Figures 12 and 13). This finding has also been associated with more aggressive clinical behavior and worse long-term prognosis (Alvarado AS, Andeen NK, Brodsky S, et al. 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]).
See the chapter: IgA Nephropathy of our Tutorial.
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References
- Sugiyama M, Wada Y, Kanazawa N, et al. A cross-sectional analysis of clinicopathologic similarities and differences between Henoch-Schönlein purpura nephritis and IgA nephropathy. PLoS One. 2020;15(4):e0232194. [PubMed link]
- Trimarchi H, Coppo R. Glomerular endothelial activation, C4d deposits and microangiopathy in immunoglobulin A nephropathy [published online ahead of print, 2019 Nov 22]. Nephrol Dial Transplant. 2019. [PubMed link]
- Alvarado AS, Andeen NK, Brodsky S, et al. 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]
- 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):253‐258. [PubMed link]
- 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):2533‐2536. [PubMed link]
- 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):404‐409. [PubMed link]