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Comprehensive evaluation of the significance of immunofluorescent findings on clinicopathological features in IgA nephropathy

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Abstract

Background

The clinicopathological significance of immunofluorescent findings in IgA nephropathy remains controversial.

Methods

The relations of the deposition of IgA, IgG, IgM, C3, C1q and fibrinogen (Fib) with pathological findings, baseline clinical findings, and renal outcome were evaluated in 688 patients with IgA nephropathy. Pathological features included cellular or fibrocellular crescents, endocapillary or mesangial hypercellularity, segmental or global glomerulosclerosis and the Oxford classification.

Results

The median age at biopsy was 30 years. There were 289 men. With 74 months median follow-up, 32% of patients received steroids. Twelve percent of patients developed end-stage renal disease (ESRD). The degree of IgA was closely related to the degree of C3, IgG and IgM deposition. The degree of IgA, C3, IgG and Fib deposition was significantly related to the percentage of glomeruli with crescent, endocapillary and mesangial hypercellularity. IgM deposition showed significant association with crescent, mesangial hypercellularity, segmental sclerosis, global glomerulosclerosis and tubular atrophy/interstitial fibrosis. In the patients treated with steroids, the risk for ESRD in patients with 2–3+ IgA deposition was significantly lower with reference of 1+ IgA deposition.

Conclusion

We found the different roles of glomerular immune reactants’ deposition in the inflammatory process from acute to chronic stage. IgA deposition together with IgG, Fib and C3 may produce acute inflammatory injury. IgM deposition might occur in the early stage of inflammation and remains until late sclerotic stage. The prominent deposition of IgA related to low risk for ESRD in patients who received steroids might suggest effectiveness of steroids in such patients.

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Acknowledgements

The authors are grateful to Mr. Mikio Munakata for technical assistance; cutting frozen section, staining sections for immunofluorescent study, and evaluating the intensity of deposition of IgG, IgA, IgM, C3, C1q and fibrinogen in all biopsies in this study.

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Authors and Affiliations

  1. Kidney Unit, National Fukuoka-Higashi Medical Center, 1-1-1, Chidori, Koga, Fukuoka, 811-3195, Japan

    Ritsuko Katafuchi & Hiroshi Nagae

  2. Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Kosuke Masutani

  3. Department of Nephrology, Nara Medical University, Nara, Japan

    Kazuhiko Tsuruya

  4. Kidney Unit, Fukuoka Red Cross Hospital, Fukuoka, Japan

    Koji Mitsuiki

Authors
  1. Ritsuko Katafuchi
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  2. Hiroshi Nagae
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  3. Kosuke Masutani
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  4. Kazuhiko Tsuruya
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  5. Koji Mitsuiki
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Corresponding author

Correspondence to Ritsuko Katafuchi.

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Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in this study were in accordance with ethical standards of the Hospital Review Board (IRB)/Ethic Committees at National Fukuoka Higashi Medical Center and Fukuoka Red Cross Hospital (IRB approval numbers: 28–37 and 351, respectively) and with Ethical Guidelines for Medical and Health Research Involving Human Subjects by Ministry of Health, Labor and Welfare in Japan.

Informed consent

Since this was a retrospective study and used a preexisting database while employing the highest privacy policy standards, the investigators shall not necessarily be required to obtain informed consent. However, we made public information concerning this study on the web (http://www.fe-med.jp/ and http://www.fukuoka-med.jrc.or.jp/) and ensured the opportunities for the research subjects to refuse utilizing their personal information.

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Katafuchi, R., Nagae, H., Masutani, K. et al. Comprehensive evaluation of the significance of immunofluorescent findings on clinicopathological features in IgA nephropathy. Clin Exp Nephrol 23, 169–181 (2019). https://doi.org/10.1007/s10157-018-1619-6

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  • DOI: https://doi.org/10.1007/s10157-018-1619-6

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