Garland-pattern postinfectious glomerulonephritis with IgA-dominant deposition

Abstract

A histological subtype of acute postinfectious glomerulonephritis (APIGN), the garland pattern, is identified not only by characteristic histological findings, but also by severe clinical course as compared with typical APIGN. However, since the morbidity of APIGN has decreased globally, there have been few reports on this disease form in developed countries during the last two decades. Herein, we report a case of adolescent garland-pattern APIGN with IgA-dominant deposits, presenting with severe nephrotic syndrome and protracted hematuria and proteinuria. We also review the clinical and histological features of 13 previously reported cases in Japan and compare them with our present case. In our review, we confirmed IgA deposition in at least three of these patients, in whom urinary protein excretion tended to be greater than those patients without IgA. Greater awareness of this condition is necessary to ensure appropriate follow-up of the clinical course of patients with garland-pattern APIGN with IgA deposition.

Keywords: Corticosteroid; Garland pattern; Hypocomplementemia; IgA-dominant; Nephrotic syndrome; Postinfectious glomerulonephritis.

Fig. 1

Renal biopsy findings. a Light microscopic findings of the first renal biopsy showing endocapillary proliferative glomerulonephritis with infiltrating neutrophils (arrows) by periodic acid-Schiff staining (×400). b, c Immunofluorescence showing tight deposits of C3 (b) and IgA (c) along the capillary walls and parts of the mesangium, indicating the garland pattern, as well as IgA-dominant acute postinfectious glomerulonephritis (APIGN). d, e Electron microscopic findings of the first renal biopsy showing subepithelial deposits (d ×2,000, e ×6,500). f Light microscopic findings of the second renal biopsy: endocapillary proliferation of the glomeruli had disappeared, although diffuse mesangial proliferation persisted on periodic acid-Schiff staining (×400). g, h Immunofluorescence showing deposits of C3 (g) and IgA (h) in the mesangial region, indicating mesangial-pattern APIGN. i Electron microscopic findings of the second renal biopsy showing a small amount of deposits in the subepithelial, subendothelial, and paramesangial areas (×2,000)

Fig. 2

Clinical course during the first 4 months