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. 2013 Feb;17(1):73-82.
doi: 10.1007/s10157-012-0660-0. Epub 2012 Jul 3.

Clinical significance of IgG deposition in the glomerular mesangial area in patients with IgA nephropathy

Yukihiro Wada  1 , Hiroaki Ogata, Yui Takeshige, Akiko Takeshima, Noriyo Yoshida, Masahiro Yamamoto, Hidetoshi Ito, Eriko Kinugasa
Affiliations

Clinical significance of IgG deposition in the glomerular mesangial area in patients with IgA nephropathy

Yukihiro Wada et al. Clin Exp Nephrol. 2013 Feb.

Abstract

Background: Immunoglobulin (Ig) A nephropathy (IgAN) is characterized by mesangial deposits of IgA1 and C3, often with co-deposits of IgG. We attempted to clarify the clinical significance of mesangial IgG deposition in patients with IgAN.

Methods: We retrospectively reviewed 57 patients who were diagnosed with IgAN on the basis of pathological examination of renal biopsy specimens obtained between October 2006 and December 2010. Subjects were divided into two groups: IgA+IgG deposition (IgA-IgG) group (n = 29) and IgA deposition alone (IgA) group (n = 28). The study outcome was complete remission (CR), defined as negative proteinuria by dipstick urinalysis and urinary erythrocytes of less than 1-4/high-power field.

Results: Proteinuria was greater in the IgA-IgG group than the IgA group (1.1 ± 0.8 vs. 0.7 ± 0.6 g/day, Mann-Whitney U test, P = 0.042). Capillary wall IgA deposits were noted more frequently in the IgA-IgG group than the IgA group (59 vs. 11 %, Fisher's exact test, P = 0.014). During the median follow-up period of 33.3 months (range 6-55 months) in the 57 patients, we observed CR in 24 cases (42.1 %). After the start of treatment, urinary abnormalities disappeared earlier in the IgA group than in the IgA-IgG group (log rank test, P = 0.012). Cox's regression model showed that IgG deposition reduced the hazard ratio for CR (hazard ratio 0.35; 95 % confidence interval 0.14-0.82, P = 0.014). Therefore, IgG deposition is a risk factor for persistent urinary abnormalities.

Conclusion: Mesangial IgG deposition is associated with more severe clinical features in patients with IgAN.

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Figures

Fig. 1
Fig. 1
Assessment of IgG deposits. The extent of IgG deposition was graded on a 4-point scale: grade 0, absent; grade 1, weak; grade 2, moderate; grade 3, severe
Fig. 2
Fig. 2
a, b Glomerular mesangial immunofluorescence findings (stained with fluorescein isothiocyanate-conjugated monospecific antisera against human IgG, IgA, IgM and C3c). a Typical images in the IgA-IgG group. b Typical images in the IgA group
Fig. 3
Fig. 3
Cumulative probability of complete remission between IgA-IgG and IgA groups. Probability was analyzed by the log-rank test (P = 0.012)
See this image and copyright information in PMC

Comment in

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