Format

Send to

Choose Destination
Hum Pathol. 2018 Nov;81:272-280. doi: 10.1016/j.humpath.2018.06.031. Epub 2018 Jul 3.

IgA-dominant glomerulonephritis with a membranoproliferative pattern of injury.

Author information

1
Oregon Health & Science University, Department of Pathology, Portland, OR 97239. Electronic address: andeen@ohsu.edu.
2
University of Washington, Department of Medicine, Division of Nephrology, Seattle, WA 98195.
3
University of Washington, Department of Pathology, Seattle, WA 98195.
4
St Paul Hospital, University of British Columbia, Department of Pathology, Vancouver, BC V6Z1Y6, Canada.
5
University of Washington, Department of Pathology, Seattle, WA 98195; Seattle Children's Hospital, Department of Pathology, Seattle, Wa, 98105.
6
Stanford University, Department of Pathology, Stanford, CA 94305.
7
Oregon Health & Science University, Department of Pathology, Portland, OR 97239.
8
University of Washington, Department of Pathology, Seattle, WA 98195; Seattle Veterans Affairs Medical Center, Seattle, WA 98108.

Abstract

Immunoglobulin A (IgA)-dominant membranoproliferative glomerulonephritis (MPGN) is a descriptive term for renal biopsies in which differential diagnoses of unusual IgA nephropathy (IgAN), infection-related GN, or other etiologies are considered. We sought to understand clinical and pathologic features of this finding. Native kidney biopsies with IgA-dominant immune deposits and diffuse MPGN features without significant exudative features or subepithelial deposits were retrospectively reviewed. Two groups (n = 27, 33 biopsies) were identified: patients with chronic liver disease and those without. Patients without chronic liver disease (n = 15) were men (73%, age 40) who presented with nephrotic-range proteinuria, hematuria, renal insufficiency, negative serologic studies, and no history of infection. At a median interval of 3 years, 11 had available follow-up information. Three (27%) progressed to end-stage renal disease. One had recurrent IgA-dominant GN in the renal allograft less than 1 year posttransplant. Four of 5 patients with repeat biopsies had persistent IgA-dominant MPGN. Patients with chronic liver disease (n = 12) had similar biopsy findings, but 42% had concurrent infections, some occult. At a median interval of 7 weeks, 8 patients (80% of those with follow-up) had died and 2 were dialysis dependent. In conclusion, IgA-dominant MPGN was seen in 2 clinical cohorts in this study. In patients without chronic liver disease, this appears to represent either a unique clinicopathologic entity with a poorer prognosis than IgAN or an aggressive variant of IgAN. Patients with chronic liver disease often have underlying infection, and regardless of treatment, die within 1 year because of complex medical conditions.

KEYWORDS:

Hepatitis; IgA; Infection; Kidney biopsy; Liver failure; Membranoproliferative glomerulonephritis

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center