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Significance of subepithelial deposits in patients diagnosed with IgA nephropathy

Subepithelial deposits are observed in rare adult IgA nephropathy (IgAN) cases and are a key diagnostic finding in IgA-dominant infection-related glomerulonephritis (IgA-IRGN). Sometimes, it is difficult to distinguish IgA-IRGN from IgAN without a precise clinical history. We hypothesized that some...

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Autores principales: Kitamura, Mineaki, Obata, Yoko, Ota, Yuki, Muta, Kumiko, Yamashita, Hiroshi, Harada, Takashi, Mukae, Hiroshi, Nishino, Tomoya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382354/
https://www.ncbi.nlm.nih.gov/pubmed/30785896
http://dx.doi.org/10.1371/journal.pone.0211812
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author Kitamura, Mineaki
Obata, Yoko
Ota, Yuki
Muta, Kumiko
Yamashita, Hiroshi
Harada, Takashi
Mukae, Hiroshi
Nishino, Tomoya
author_facet Kitamura, Mineaki
Obata, Yoko
Ota, Yuki
Muta, Kumiko
Yamashita, Hiroshi
Harada, Takashi
Mukae, Hiroshi
Nishino, Tomoya
author_sort Kitamura, Mineaki
collection PubMed
description Subepithelial deposits are observed in rare adult IgA nephropathy (IgAN) cases and are a key diagnostic finding in IgA-dominant infection-related glomerulonephritis (IgA-IRGN). Sometimes, it is difficult to distinguish IgA-IRGN from IgAN without a precise clinical history. We hypothesized that some IgA-IRGN cases might be diagnosed as IgAN with subepithelial deposits (IgAN-SD) and aimed to clarify the significance of subepithelial deposits in patients diagnosed with IgAN. We examined 464 patients diagnosed with IgAN at Nagasaki University Hospital and affiliated hospitals between 1996 and 2013. The differences in clinicopathological findings between IgAN-SD and IgAN with no subepithelial deposits (IgAN-NSD) were investigated. In addition to clinical data and typical IgAN pathological features, we analyzed complement levels, immunoglobulin localization, light chain staining patterns, and intramembranous deposits. There were 214 men and 250 women with a mean age of 38.8 ± 18.3 years. Subepithelial deposition was observed in 51 patients (11%). Compared to patients with IgAN-NSD, those with IgAN-SD had significantly lower mean serum protein (6.4 g/dL vs. 6.7 g/dL; p = 0.02), albumin (3.7 g/dL vs. 3.9 g/dL; p = 0.02), and complement (C3) (94 mg/dL vs. 103 mg/dL; p = 0.02) levels. Diffuse mesangial hypercellularity (M) (65% vs. 45%; p<0.01), endocapillary hypercellularity: (E) (43% vs. 28%; p = 0.03), and IgA staining in the glomerular capillary wall (22% vs. 8%; p<0.01) were more common in patients with IgAN-SD. The incidence of light chain lambda predominance was lower in patients with IgAN-SD (47% vs. 63%; p = 0.03). Hump-shaped subepithelial deposits and intramembranous deposits were observed in nine and 17 patients with IgAN-SD, respectively. Patients with IgAN-SD tended to have the characteristics of IgA-IRGN rather than IgAN-NSD. Since the therapeutic strategies for IgA-IRGN differ from those for IgAN, we should review the clinical history and pay careful attention to the clinical course in cases with atypical findings, such as subepithelial deposits.
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spelling pubmed-63823542019-03-01 Significance of subepithelial deposits in patients diagnosed with IgA nephropathy Kitamura, Mineaki Obata, Yoko Ota, Yuki Muta, Kumiko Yamashita, Hiroshi Harada, Takashi Mukae, Hiroshi Nishino, Tomoya PLoS One Research Article Subepithelial deposits are observed in rare adult IgA nephropathy (IgAN) cases and are a key diagnostic finding in IgA-dominant infection-related glomerulonephritis (IgA-IRGN). Sometimes, it is difficult to distinguish IgA-IRGN from IgAN without a precise clinical history. We hypothesized that some IgA-IRGN cases might be diagnosed as IgAN with subepithelial deposits (IgAN-SD) and aimed to clarify the significance of subepithelial deposits in patients diagnosed with IgAN. We examined 464 patients diagnosed with IgAN at Nagasaki University Hospital and affiliated hospitals between 1996 and 2013. The differences in clinicopathological findings between IgAN-SD and IgAN with no subepithelial deposits (IgAN-NSD) were investigated. In addition to clinical data and typical IgAN pathological features, we analyzed complement levels, immunoglobulin localization, light chain staining patterns, and intramembranous deposits. There were 214 men and 250 women with a mean age of 38.8 ± 18.3 years. Subepithelial deposition was observed in 51 patients (11%). Compared to patients with IgAN-NSD, those with IgAN-SD had significantly lower mean serum protein (6.4 g/dL vs. 6.7 g/dL; p = 0.02), albumin (3.7 g/dL vs. 3.9 g/dL; p = 0.02), and complement (C3) (94 mg/dL vs. 103 mg/dL; p = 0.02) levels. Diffuse mesangial hypercellularity (M) (65% vs. 45%; p<0.01), endocapillary hypercellularity: (E) (43% vs. 28%; p = 0.03), and IgA staining in the glomerular capillary wall (22% vs. 8%; p<0.01) were more common in patients with IgAN-SD. The incidence of light chain lambda predominance was lower in patients with IgAN-SD (47% vs. 63%; p = 0.03). Hump-shaped subepithelial deposits and intramembranous deposits were observed in nine and 17 patients with IgAN-SD, respectively. Patients with IgAN-SD tended to have the characteristics of IgA-IRGN rather than IgAN-NSD. Since the therapeutic strategies for IgA-IRGN differ from those for IgAN, we should review the clinical history and pay careful attention to the clinical course in cases with atypical findings, such as subepithelial deposits. Public Library of Science 2019-02-20 /pmc/articles/PMC6382354/ /pubmed/30785896 http://dx.doi.org/10.1371/journal.pone.0211812 Text en © 2019 Kitamura et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kitamura, Mineaki
Obata, Yoko
Ota, Yuki
Muta, Kumiko
Yamashita, Hiroshi
Harada, Takashi
Mukae, Hiroshi
Nishino, Tomoya
Significance of subepithelial deposits in patients diagnosed with IgA nephropathy
title Significance of subepithelial deposits in patients diagnosed with IgA nephropathy
title_full Significance of subepithelial deposits in patients diagnosed with IgA nephropathy
title_fullStr Significance of subepithelial deposits in patients diagnosed with IgA nephropathy
title_full_unstemmed Significance of subepithelial deposits in patients diagnosed with IgA nephropathy
title_short Significance of subepithelial deposits in patients diagnosed with IgA nephropathy
title_sort significance of subepithelial deposits in patients diagnosed with iga nephropathy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382354/
https://www.ncbi.nlm.nih.gov/pubmed/30785896
http://dx.doi.org/10.1371/journal.pone.0211812
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