Go back to clinical information and images

Diagnosis: Postinfectious glomerulonephritis superimposed on a nephrotic glomerulopathy, probably minimal change disease

There are few reports on patients with double glomerulopathy, involving either the coexistence of two different glomerulopathies or superimposition of a second glomerulopathy onto a first.

Original glomerulopathies are those with a chronic course, such as IgA nephropathy, relapsing minimal-change nephrotic syndrome, membranous glomerulonephritis, Alport syndrome, and thin basement membrane nephropathy. The superimposing glomerulopathies are common types, such as postinfectious glomerulonephritis, IgA nephropathy, and Henoch-Schönlein nephritis. Thus, the pattern of double glomerulopathy is considered to be due to the chance occurrence of two different glomerulopathies without a common pathogenesis. Acute nephritic symptoms of superimposed glomerulopathies resolve almost completely during follow-up in most cases. Double glomerulopathies are not rare in and may occur by chance alone in most cases. The possibility of superimposed glomerulopathy should be suspected if the clinical course of a glomerulopathy changes atypically. However, the long-term influence of a superimposed glomerulopathy on renal functional deterioration remains unclear (Cheong HI, et al. Pattern of double glomerulopathy in children. Pediatr Nephrol. 2007;22:521-7. [PubMed link]).

Anti-glomerular basement membrane (GBM) nephritis superimposed on membranous nephropathy is another common double glomerulopathy combination. For this combination, one could speculate that subepithelial immune deposits in membranous nephropathy might alter the GBM and cause release of normal or altered endogenous GBM components into the circulation, and the resultant formation of anti-GBM antibodies. However, the precise mechanism is obscure.

It is controversial whether a superimposed glomerulopathy affects the long-term prognosis of an original glomerular disease. In a series by Cheong et al, acute nephritic features of superimposed glomerulopathies, even those of postinfectious crescentic glomerulonephritis, subsided in all cases (5 cases of postinfectious GN). However, in cases with persistent proteinuria and/or hematuria, they were unable to assess the adverse effect of superimposing glomerulopathies because the original glomerulopathies had the same renal phenotypes. (Cheong HI, et al. Pattern of double glomerulopathy in children. Pediatr Nephrol. 2007;22:521-7. [PubMed link]). Follow-up renal biopsies may provide answers.

See the chapters Proliferative Endocapillary Glomerulonephritis and Minimal Change Disease in our Tutorial.

Go back to clinical information and images

Bibliography

• CLim BJ, Suh KS, Na KR, Lee KW, Shin YT. Acute poststreptococcal glomerulonephritis superimposed on IgA nephropathy. Clin Nephrol. 2008;70(2):155-8. [PubMed link]
• Cheong HI, Cho HY, Moon KC, Ha IS, Choi Y. Pattern of double glomerulopathy in children. Pediatr Nephrol. 2007;22:521-7. [PubMed link]
• Hoshino J, Hara S, Ubara Y, Takaya H, Suwabe T, Sawa N, Tagami T, Katori H, Takemoto F, Hara S, Takaichi K. Distribution of IgG subclasses in a biopsy specimen showing membranous nephropathy with anti-glomerular basement membrane glomerulonephritis: an uncharacteristically good outcome with corticosteroid therapy. Am J Kidney Dis. 2005;45(4):e67-72. [PubMed link]
• Horita Y, Tadokoro M, Taura K, Suyama N, Taguchi T, Miyazaki M, Kohno S. Histologically confirmed superimposition of post-streptococcal acute glomerulonephritis during IgA nephropathy. Clin Exp Nephrol. 2004;8(4):351-5. [PubMed link]
• Masutani K, Mizumasa T, Iwanaga T, Shinozaki M, Yanagida T, Kashiwagi M, Fukuda K, Kanai H, Katafuchi R, Hirakata H. Superimposition of post-streptococcal acute glomerulonephritis on the course of IgA nephropathy: predominance of Th1 type immune response. Clin Nephrol. 2002;58(3):224-30. [PubMed link]
• Monga G, Mazzucco G, Barbiano di Belgiojoso G, Confalonieri R, Sacchi G, Bertani T. Pattern of double glomerulopathies. A clinicopathologic study in nine nondiabetic patients. Nephron. 1990;56(1):73-80. [PubMed link]

[Top]

Go back to clinical information and images