Characterization of IgA Deposition in the Kidney of Patients with IgA Nephropathy and Minimal Change Disease

被引:9
作者
Cho, Won-Hee [1 ]
Park, Seon-Hwa [2 ]
Choi, Seul-Ki [2 ]
Jung, Su Woong [2 ]
Jeong, Kyung Hwan [3 ]
Kim, Yang-Gyun [2 ]
Moon, Ju-Young [2 ]
Lim, Sung-Jig [4 ]
Sung, Ji-Youn [5 ]
Jhee, Jong Hyun [6 ]
Chin, Ho Jun [7 ,8 ]
Choi, Bum Soon [9 ]
Lee, Sang-Ho [2 ]
机构
[1] Kyung Hee Univ, Grad Sch, Dept Med, Seoul 02447, South Korea
[2] Kyung Hee Univ Hosp Gangdong, Dept Internal Med, Div Nephrol, Seoul 05278, South Korea
[3] Kyung Hee Univ, Dept Internal Med, Div Nephrol, Med Ctr, Seoul 02447, South Korea
[4] Kyung Hee Univ, Kyung Hee Univ Hosp Gangdong, Dept Pathol, Seoul 05278, South Korea
[5] Kyung Hee Univ, Kyung Hee Univ Hosp, Dept Pathol, Coll Med, Seoul 02447, South Korea
[6] Yonsei Univ, Gangnam Severance Hosp, Dept Internal Med, Div Nephrol,Coll Med, Seoul 06273, South Korea
[7] Seoul Natl Univ, Dept Internal Med, Bundang Hosp, Seongnam 13620, South Korea
[8] Seoul Natl Univ, Coll Med, Dept Internal Med, Seoul 03080, South Korea
[9] Catholic Univ Korea, Coll Med, Dept Internal Med, Div Nephrol, Seoul 06591, South Korea
基金
新加坡国家研究基金会;
关键词
IgA nephropathy with minimal change disease; nephrotic syndrome; galactose-deficient IgA1; KM55; double immunofluorescent staining; NEPHROTIC SYNDROME; CLINICOPATHOLOGICAL CHARACTERISTICS;
D O I
10.3390/jcm9082619
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Approximately 5% of patients with IgA nephropathy (IgAN) exhibit mild mesangial lesions with acute onset nephrotic syndrome and diffuse foot process effacement representative of minimal change disease (MCD). It is not clear whether these unusual cases of IgAN with MCD (IgAN-MCD) are variant types of IgAN or coincidental deposition of IgA in patients with MCD. In a retrospective multicenter cohort study of 18 hospitals in Korea, we analyzed 46 patients with IgAN-MCD. Patients with endocapillary proliferation, segmental sclerosis, and crescent were excluded, and the clinical features and prognosis of IgAN-MCD were compared with those of pure MCD. In addition, we performed galactose-deficient IgA1 (KM55) staining to characterize IgAN-MCD. Among the 21,697 patients with glomerulonephritis enrolled in the database, 46 patients (0.21%) were diagnosed with IgAN-MCD, and 1610 patients (7.4%) with pure MCD. The 46 patients with IgAN-MCD accounted for 0.6% of primary IgAN patients (n= 7584). There was no difference in prognosis between patients with IgAN-MCD and those with only MCD. IgA and KM55 showed double positivity in all patients with IgAN-MCD (n= 4) or primary IgAN (n= 5) under double immunofluorescent staining. However, in four patients with lupus nephritis, mesangial IgA was deposited, but galactose-deficient-IgA1 (Gd-IgA1) was not. These findings suggest that IgAN-MCD is a dual glomerulopathy in which MCD was superimposed on possibly indolent IgAN. We confirmed by KM55 staining that IgAN-MCD is true IgAN, enabling better characterizations of the disease. Furthermore, IgAN-MCD shows a good prognosis when treated according to the usual MCD treatment modality.
引用
收藏
页码:1 / 11
页数:11
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