Focal segmental glomerulosclerosis plays a major role in the progression of IgA nephropathy. II. Light microscopic and clinical studies

被引:104
作者
El Karoui, Khalil [1 ,2 ]
Hill, Gary S. [1 ]
Karras, Alexandre [3 ]
Moulonguet, Luc [4 ]
Caudwell, Valerie [5 ]
Loupy, Alexandre [1 ]
Bruneval, Patrick [1 ]
Jacquot, Christian [3 ]
Nochy, Dominique [1 ]
机构
[1] Hop Europeen Georges Pompidou, Dept Pathol, Paris, France
[2] Hop Necker Enfants Malad, INSERM, U845, Paris, France
[3] Hop Europeen Georges Pompidou, Dept Nephrol, Paris, France
[4] Hop Ambroise Pare, Dept Nephrol, Boulogne Billancourt, France
[5] Hop Sud Francilien, Dept Nephrol, Evry, France
关键词
focal segmental glomerulosclerosis; IgA nephropathy; podocytes; podocytopathy; IMMUNOGLOBULIN-A NEPHROPATHY; PARIETAL EPITHELIAL-CELLS; PODOCYTE INJURY; OXFORD CLASSIFICATION; GLOMERULAR PODOCYTES; NEPHRIN EXPRESSION; KIDNEY-DISEASES; DOWN-REGULATION; PATHOGENESIS; TRANSDIFFERENTIATION;
D O I
10.1038/ki.2010.460
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
It is well known that lesions morphologically identical with focal segmental glomerulosclerosis (FSGS) may appear in IgA nephropathy (IgAN). Capsular adhesions without underlying abnormalities in the tuft, often the first sign of FSGS, are frequent in IgAN. In this retrospective study, a new cohort of 128 adult patients with IgAN was used to validate the new Oxford classification system of IgAN, and shown to have highly significant associations with clinical and outcome parameters. We then used these patients to determine the extent to which IgAN could be accounted for in terms of FSGS. Some form of lesion consistent with FSGS, notably hyalinosis and collapsing glomerulopathy, was found in 101 of these patients. No glomerular lesions were found in 16 patients, and 11 had mild lesions not definable as FSGS. Those with FSGS had significantly worse renal survival at 80 months than those without. Comparison of pure forms of FSGS (excluding collapsing glomerulopathy) with cases of FSGS having other glomerular lesions (mesangial hyperplasia, endocapillary hypercellularity, glomerular necroses, extracapillary proliferation) revealed that those with FSGS and other superimposed lesions did significantly worse than cases of pure FSGS at 80 months following diagnosis. Importantly, patients with pure FSGS had relatively poor survival even without other superimposed glomerular abnormalities. Thus, the majority of cases of IgAN can be interpreted as representing one or another variant of FSGS. Hence, interpreting IgAN in terms of FSGS emphasizes the role that podocyte lesions may play in the pathogenesis and progression of this disease. Kidney International (2011) 79, 643-654; doi: 10.1038/ki.2010.460; published online 22 December 2010
引用
收藏
页码:643 / 654
页数:12
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