Abstract
Seventy-three patients with IgA nephropathy (IgAGN), under the age of 15 years at the time of the discovery of the disease, were investigated with respect to glomerular basement membrane (GBM) lesions. Irregular attenuation or widening of GBM, especially on the epithelial side, was observed in 28 cases (38%). These two changes are referred to aslysis of GBM and were considered to be the primary and specific changes among the GBM lesions in IgAGN. GBM thickening with layering of lamina densa was found in 37 of 73 cases (51%), but this change has been observed in other types of glomerular diseases. GBM lesions similar to those seen in IgAGN were also observed in Henoch-Schönlein purpura nephritis (HSPN) and poststreptococcal acute glomerulonephritis (PSAGN). Lysis of GBM was observed only in IgAGN, HSPN and PSAGN. Subepithelial and intramembranous deposits appeared to have an important role in the development of these GBM lesions. The presence of GBM lesions was correlated with a high incidence of cellular crescents but not with other clinical or light microscopic findings. The presence of these GBM lesions in IgAGN does not have a significant effect on the prognosis, at least in childhood. The affected GBM seemed to recover without leaving any significant residual damage in most cases. In the long-term prognosis of the disease non-immunological factors, such as ageing or hypertension, seem to be important.
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References
Levy M, Beaufils H, Gubler MC, Habib R (1975) Idiopathic recurrent macroscopic hematuria and IgA-IgG deposit in children (Berger's disease). Clin Nephrol 1: 63–64
Ueda Y, Sakai O, Yamagata M, Kitajima T, Kawamura K (1977) IgA glomerulonephritis in Japan. Contrib Nephrol 4: 36–42
Hood SA, Velosa JA, Holey KE, Donadio JV Jr (1981) IgA-IgG nephropathy: predictive indices of progressive disease. Clin Nephrol 6: 55–62
Bennet WM, Kincaid-Smith P (1983) Macroscopic hematuria in mesangial IgA nephropathy: correlation with glomerular crescents and renal dysfunction. Kidney Int 23: 393–400
Clarkson AR, Seymour AE, Thompson AJ, Haynes WDG, Chan Y-L, Jackson B (1977) IgA nephropathy: a syndrome of uniform morphology, diverse clinical features and uncertain prognosis. Clin Nephrol 8: 459–471
Kusumoto Y, Takebayashi S, Taguchi T, Harada T, Naito S (1987) Long-term prognosis and prognostic indices of IgA nephropathy in juvenile and in adult Japanese. Clin Nephrol 28: 118–124
Tateno S, Kobayashi Y (1987) Quantitative analysis of mesangial areas in serial biopsied patients with IgA nephropathy. Nephron 46: 28–33
Yoshikawa N, Yoshiara S, Yoshiya K, Matsuo T (1986) Lysis of the glomerular basement membrane in children with IgA nephropathy and Henoch-Schönlein nephritis. J Pathol 150: 119–126
Terasaki T, Sano M, Narita M, Tojo S (1986) Ultrastructural study of gaps of the glomerular basement membrane in IgA nephropathy. Am J Nephrol 6: 443–449
Gartner H-V, Honlein F, Traub U, Bohle A (1979) IgA nephropathy (IgA-IgG nephropathy/IgA nephritis): a disease entity? Virchows Arch [Pathol Anat] 385: 1–27
Navas Palacios JJ, Gutoerrez-Millet LV, Uisra-Sarraga G, Garzon-Martin A (1981) IgA nephropathy: an ultrastructural study. Ultrastruct Pathol 2: 151–161
Ng WL, Chan CW, Yeung CK, Hua SP (1981) The pathology of primary IgA nephritis: a renal biopsy study. Pathology 13: 137–143
Shigematsu H, Kobayashi Y, Tateno S, Hiki Y, Kuwano S (1982) Ultrastructural glomerular loop abnormalities in IgA nephritis. Nephron 30: 1–7
Morita M, Sakaguchi H (1988) A quantitative study of glomerular basement membrane changes in IgA nephropathy. J Pathol 154: 7–18
Morita T, Suzuki Y, Churg J (1973) Structure and development of the glomerular crescent. Am J Pathol 72: 349–368
Bohman SO, Olsen S, Peterson VP (1974) Glomerular ultrastructure in extracapillary glomerulonephritis. Acta Pathol Microbiol Scand [A] 82: 29–54
Mihatsch MJ, Imbasciati E, Fogazzi G, Giani M, Ghio L, Gaboardi F (1984) Ultrastructural lesions of Henoch-Schönlein syndrome and of IgA nephropathy: similarities and differences. Contrib Nephrol 40: 255–263
Brun C, Bryld C, Fenger L, Jorgensen F (1971) Glomerular lesions in adults with Schönlein-Henoch syndrome: a light and electron microscopic study. Acta Pathol Microbiol Scand [A] 79: 569–583
Zollinger HU, Mihatsch MJ, Gaboardi F, Banfi G, Edefonti A, Bardare M, Gudat F (1980) Schönlein-Henoch glomerulonephritis: characteristic ultrastructural changes in the glomerular basement membrane and location of osmiophlic deposits. Virchow Arch [Pathol Anat] 388: 155–165
Katz A, Walker JF, Land PJ (1983) IgA nephritis with nephrotic range proteinuria. Clin Nephrol 20: 67–71
Mustonen J, Pasternack AP, Rantala I (1983) The nephrotic syndrome in IgA glomerulonephritis: response to corticosteroid therapy. Clin Nephrol 20: 172–176
Alex B, Magil MD, Louis D, Wadsworth MB (1981) Monocytes in human glomerulonephritis: an electron microscopic study. Lab Invest 45: 77–81
Monga G, Mazzucco G, Barbiano di Belgiozoso G, Chil Busnach G (1981) Monocytes infiltration and glomerular hypercellularity in human acute and persistent glomerulonephritis: light and electron microscopic, immunofluorescence, and histochemical investigation on twenty cases. Lab Invest 44: 381–387
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Nomura, Y., Ohya, N. & Shimada, M. A histopathological study on the prognosis of childhood IgA nephropathy and glomerular basement membrane lesions. Pediatr Nephrol 3, 242–247 (1989). https://doi.org/10.1007/BF00858523
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DOI: https://doi.org/10.1007/BF00858523