Cargando…

The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits

INTRODUCTION: Glomerulonephritis (GN) with crescents and IgA deposits in kidney biopsy poses a frequent diagnostic and therapeutic dilemma because of multiple possibilities. METHODS: Native kidney biopsies showing glomerular IgA deposition and crescents (excluding lupus nephritis) were identified fr...

Descripción completa

Detalles Bibliográficos
Autores principales: Kitamura, Mineaki, Almaani, Salem, Challa, Bindu, Doraiswamy, Mohankumar, Ayoub, Isabelle, Biederman, Laura, Parikh, Samir V., Molovic-Kokovic, Ana, Benedict, Jason, Mhaskar, Nilesh, Khitan, Zeid J., Brodsky, Sergey V., Nadasdy, Tibor, Satoskar, Anjali A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10014387/
https://www.ncbi.nlm.nih.gov/pubmed/36938067
http://dx.doi.org/10.1016/j.ekir.2022.12.024
_version_ 1784906984120647680
author Kitamura, Mineaki
Almaani, Salem
Challa, Bindu
Doraiswamy, Mohankumar
Ayoub, Isabelle
Biederman, Laura
Parikh, Samir V.
Molovic-Kokovic, Ana
Benedict, Jason
Mhaskar, Nilesh
Khitan, Zeid J.
Brodsky, Sergey V.
Nadasdy, Tibor
Satoskar, Anjali A.
author_facet Kitamura, Mineaki
Almaani, Salem
Challa, Bindu
Doraiswamy, Mohankumar
Ayoub, Isabelle
Biederman, Laura
Parikh, Samir V.
Molovic-Kokovic, Ana
Benedict, Jason
Mhaskar, Nilesh
Khitan, Zeid J.
Brodsky, Sergey V.
Nadasdy, Tibor
Satoskar, Anjali A.
author_sort Kitamura, Mineaki
collection PubMed
description INTRODUCTION: Glomerulonephritis (GN) with crescents and IgA deposits in kidney biopsy poses a frequent diagnostic and therapeutic dilemma because of multiple possibilities. METHODS: Native kidney biopsies showing glomerular IgA deposition and crescents (excluding lupus nephritis) were identified from our biopsy archives between 2010 and 2021. Detailed clinicopathologic features were assessed. One-year clinical follow-up on a subset of cases was obtained. RESULTS: A total of 285 cases were identified, and these clustered into IgA nephropathy (IgAN, n = 108), Staphylococcus or other infection-associated GN/infection-related GN (SAGN/IRGN, n = 43), and antineutrophil cytoplasmic antibody–associated GN (ANCA-GN, n = 26) based on a constellation of clinicopathologic features, but 101 cases (group X) could not be definitively differentiated. The reasons have been elucidated, most important being atypical combination of clinicopathologic features and lack of definitive evidence of active infection. Follow-up (on 72/101 cases) revealed that clinicians’ working diagnosis was IgAN in 43%, SAGN/IRGN in 22%, ANCA-GN in 28%, and others in 7% of the cases, but treatment approach varied from supportive or antibiotics to immunosuppression in each subgroup. Comparing these cases as “received immunosuppression” versus “non-immunosuppression,” only 2 features differed, namely C3-dominant staining, and possibility of recent infection (both higher in the no-immunosuppression group) (P < 0.05). Renal loss was higher in the non-immunosuppression subgroup, but not statistically significant (P = 0.11). CONCLUSION: Diagnostic overlap may remain unresolved in a substantial number of kidney biopsies with glomerular crescents and IgA deposits. A case-by-case approach, appropriate antibiotics if infection is ongoing, and consideration for cautious immunosuppressive treatment for progressive renal dysfunction may be needed for best chance of renal recovery.
format Online
Article
Text
id pubmed-10014387
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-100143872023-03-16 The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits Kitamura, Mineaki Almaani, Salem Challa, Bindu Doraiswamy, Mohankumar Ayoub, Isabelle Biederman, Laura Parikh, Samir V. Molovic-Kokovic, Ana Benedict, Jason Mhaskar, Nilesh Khitan, Zeid J. Brodsky, Sergey V. Nadasdy, Tibor Satoskar, Anjali A. Kidney Int Rep Clinical Research INTRODUCTION: Glomerulonephritis (GN) with crescents and IgA deposits in kidney biopsy poses a frequent diagnostic and therapeutic dilemma because of multiple possibilities. METHODS: Native kidney biopsies showing glomerular IgA deposition and crescents (excluding lupus nephritis) were identified from our biopsy archives between 2010 and 2021. Detailed clinicopathologic features were assessed. One-year clinical follow-up on a subset of cases was obtained. RESULTS: A total of 285 cases were identified, and these clustered into IgA nephropathy (IgAN, n = 108), Staphylococcus or other infection-associated GN/infection-related GN (SAGN/IRGN, n = 43), and antineutrophil cytoplasmic antibody–associated GN (ANCA-GN, n = 26) based on a constellation of clinicopathologic features, but 101 cases (group X) could not be definitively differentiated. The reasons have been elucidated, most important being atypical combination of clinicopathologic features and lack of definitive evidence of active infection. Follow-up (on 72/101 cases) revealed that clinicians’ working diagnosis was IgAN in 43%, SAGN/IRGN in 22%, ANCA-GN in 28%, and others in 7% of the cases, but treatment approach varied from supportive or antibiotics to immunosuppression in each subgroup. Comparing these cases as “received immunosuppression” versus “non-immunosuppression,” only 2 features differed, namely C3-dominant staining, and possibility of recent infection (both higher in the no-immunosuppression group) (P < 0.05). Renal loss was higher in the non-immunosuppression subgroup, but not statistically significant (P = 0.11). CONCLUSION: Diagnostic overlap may remain unresolved in a substantial number of kidney biopsies with glomerular crescents and IgA deposits. A case-by-case approach, appropriate antibiotics if infection is ongoing, and consideration for cautious immunosuppressive treatment for progressive renal dysfunction may be needed for best chance of renal recovery. Elsevier 2022-12-31 /pmc/articles/PMC10014387/ /pubmed/36938067 http://dx.doi.org/10.1016/j.ekir.2022.12.024 Text en © 2022 Published by Elsevier Inc. on behalf of the International Society of Nephrology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Kitamura, Mineaki
Almaani, Salem
Challa, Bindu
Doraiswamy, Mohankumar
Ayoub, Isabelle
Biederman, Laura
Parikh, Samir V.
Molovic-Kokovic, Ana
Benedict, Jason
Mhaskar, Nilesh
Khitan, Zeid J.
Brodsky, Sergey V.
Nadasdy, Tibor
Satoskar, Anjali A.
The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits
title The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits
title_full The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits
title_fullStr The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits
title_full_unstemmed The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits
title_short The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits
title_sort diagnostic conundrum of glomerular crescents with iga deposits
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10014387/
https://www.ncbi.nlm.nih.gov/pubmed/36938067
http://dx.doi.org/10.1016/j.ekir.2022.12.024
work_keys_str_mv AT kitamuramineaki thediagnosticconundrumofglomerularcrescentswithigadeposits
AT almaanisalem thediagnosticconundrumofglomerularcrescentswithigadeposits
AT challabindu thediagnosticconundrumofglomerularcrescentswithigadeposits
AT doraiswamymohankumar thediagnosticconundrumofglomerularcrescentswithigadeposits
AT ayoubisabelle thediagnosticconundrumofglomerularcrescentswithigadeposits
AT biedermanlaura thediagnosticconundrumofglomerularcrescentswithigadeposits
AT parikhsamirv thediagnosticconundrumofglomerularcrescentswithigadeposits
AT molovickokovicana thediagnosticconundrumofglomerularcrescentswithigadeposits
AT benedictjason thediagnosticconundrumofglomerularcrescentswithigadeposits
AT mhaskarnilesh thediagnosticconundrumofglomerularcrescentswithigadeposits
AT khitanzeidj thediagnosticconundrumofglomerularcrescentswithigadeposits
AT brodskysergeyv thediagnosticconundrumofglomerularcrescentswithigadeposits
AT nadasdytibor thediagnosticconundrumofglomerularcrescentswithigadeposits
AT satoskaranjalia thediagnosticconundrumofglomerularcrescentswithigadeposits
AT kitamuramineaki diagnosticconundrumofglomerularcrescentswithigadeposits
AT almaanisalem diagnosticconundrumofglomerularcrescentswithigadeposits
AT challabindu diagnosticconundrumofglomerularcrescentswithigadeposits
AT doraiswamymohankumar diagnosticconundrumofglomerularcrescentswithigadeposits
AT ayoubisabelle diagnosticconundrumofglomerularcrescentswithigadeposits
AT biedermanlaura diagnosticconundrumofglomerularcrescentswithigadeposits
AT parikhsamirv diagnosticconundrumofglomerularcrescentswithigadeposits
AT molovickokovicana diagnosticconundrumofglomerularcrescentswithigadeposits
AT benedictjason diagnosticconundrumofglomerularcrescentswithigadeposits
AT mhaskarnilesh diagnosticconundrumofglomerularcrescentswithigadeposits
AT khitanzeidj diagnosticconundrumofglomerularcrescentswithigadeposits
AT brodskysergeyv diagnosticconundrumofglomerularcrescentswithigadeposits
AT nadasdytibor diagnosticconundrumofglomerularcrescentswithigadeposits
AT satoskaranjalia diagnosticconundrumofglomerularcrescentswithigadeposits