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01-04-2021 | Hematuria | Original Article

Clinicopathological significance of glomerular capillary IgA deposition in childhood IgA nephropathy

Authors: Yuko Shima, Koichi Nakanishi, Hironobu Mukaiyama, Yu Tanaka, Takuzo Wada, Ryojiro Tanaka, Hiroshi Kaito, Kandai Nozu, Mayumi Sako, Kazumoto Iijima, Norishige Yoshikawa

Published in: Pediatric Nephrology | Issue 4/2021

Abstract

Background

IgA nephropathy (IgAN) is characterized by predominant mesangial IgA deposition. Some patients with IgAN demonstrate IgA deposition in glomerular peripheral capillaries (cap-IgA). The clinicopathological significance of cap-IgA remains incompletely investigated in children.

Methods

We retrospectively analyzed 503 consecutive cases of biopsy-proven childhood IgAN between July 1976 and June 2013 to compare clinical and pathological features between IgAN patients with and without cap-IgA.

Results

Among the 503 patients, 30 (6.0%) had cap-IgA. We found significant differences in proteinuria (2.0 vs. 0.5 g/day/m², p < 0.0001), time from onset to kidney biopsy (2.2 vs. 8.3 months, p < 0.0001), and rate of proteinuria remission after treatment (23.3% vs. 48.0%, p = 0.007) between both groups. Pathological analysis revealed significant differences in M1 (83.3% vs. 56.0%, p = 0.002), ratio of subendothelial electron dense deposits (EDDs, 58.6% vs. 16.5%, p < 0.0001) and subepithelial EDDs (48.3% vs. 16.5%, p = 0.0001), and glomerular basement membrane (GBM) lysis (58.6% vs. 27.1%, p = 0.0006) between both groups. More than half of cap-IgA patients (17/30, 56.7%), whereas only 26.2% of non-cap-IgA patients (124/473), were treated with immunosuppressive treatments. Six of 30 cases (20%) with cap-IgA reached glomerular filtration rate (GFR) categories G3a–G5 (estimated GFR < 60 ml/min/1.73 m²) at most recent observation (mean observation period: 7.0 ± 4.0 years). According to Kaplan-Meier analysis, patients with cap-IgA had significantly lower kidney survival curves than non-cap-IgA patients (72.8% vs. 97.2% at 10 years, p < 0.0001).

Conclusions

Cap-IgA is associated with acute inflammation with GBM changes, resulting in refractory heavier proteinuria. Cap-IgA may represent a poor prognostic factor.

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Title: Clinicopathological significance of glomerular capillary IgA deposition in childhood IgA nephropathy
Authors: Yuko Shima
Koichi Nakanishi
Hironobu Mukaiyama
Yu Tanaka
Takuzo Wada
Ryojiro Tanaka
Hiroshi Kaito
Kandai Nozu
Mayumi Sako
Kazumoto Iijima
Norishige Yoshikawa
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keyword: Hematuria
Published in: Pediatric Nephrology / Issue 4/2021
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-020-04772-4

At a glance: The STEP trials

Springer Medicine

Clinicopathological significance of glomerular capillary IgA deposition in childhood IgA nephropathy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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