Glomerular Hypertrophy as a Prognostic Marker in Childhood IgA Nephropathy

Abstract

A clinicopathological and morphometric analysis of glomerular hypertrophy (GH) was conducted using biopsies obtained from 52 selected pediatric patients with IgA nephropathy (IgAN). Of the 52 patients, consisting of 12 with chronic renal failure (CRF) and 40 without CRF, various clinical and morphometric parameters were compared to 10 controls with benign hematuria. The mean glomerular tuft size, mesangial area, and interstitial area all significantly increased in patients with poor prognosis when compared to the non-CRF-IgAN cases and the control cases. The glomerular capillary loop size was also significantly greater in CRF-IgAN than in non-CRF-IgAn patients (1.37 times) and the controls (1.55 times). The 10-year renal survival rates of patients with ‘large’ loop size (>1.55-fold) were significantly lower (p < 0.001) than those of patients with a smaller capillary loop size. The size of the capillary loops was directly related to the relative interstitial area (A_int) (r² = 0.43, p < 0.001), to the degree of glomerulosclerosis (GS; r² = 0.348, p < 0.001) and the mesangial area (r² = 0.326, p < 0.001). Proteinuria tightly correlated with the capillary loop size (r² = 0.374, p < 0.001). It was not unexpected that a strong relationship was detected between the serum creatinine level and A_int (r² = 0.452, p < 0.001) and the percentage of GS (r² = 0.342, p < 0.001). In IgAN the percentage of GS correlated significantly with A_int (r² = 0.484, p < 0.001). GH, which was manifested by glomerular capillary loop dilatation, shows a close correlation with the interstitial expansion, degree of GS and mesangial enlargement. These data suggest that both extra- and intraglomerular hemodynamic changes followed by primary glomerular damage thus lead to capillary dilatation of the intact glomeruli as a morphological manifestation of GH and therefore such changes play a key role in the progression of IgAN.

Prognosis of Renal Amyloidosis: A Clinicopathological Study Using Cluster Analysis

“…We used the point-counting method [11]to evaluate amyloid deposition in the tubular basement membrane and/or interstitium. Under high magnification (×400) using an 81-point (100-square) eyepiece micrometer, at least 10 consecutive nonoverlapping cortical fields were analyzed from each biopsy section.…”

Mechanisms of Chronic Renal Allograft Rejection. II. Progressive Allograft Glomerulopathy in Miniature Swine

“…For the evaluation of (5) glomerular hypertrophy (glomerular tuft area in glomerular cross-section), (6) activated mesangial cells (␣-actinϩ area in glomerular crosssection), and (7) mesangial matrix accumulation (periodic acid silver methenamineϩ area in glomerular cross-section), 40 cross-sections of glomeruli were assessed by Luzex IIIU digital image processor analyzer (Nireco, Tokyo, Japan), and expressed in m 2 , as described previously (Masseroli et al, 1998;Nishimoto et al, 1997;Tóth and Takebayashi, 1998). These results were expressed as the mean Ϯ SD or SEM, and statistical analysis was performed using the unpaired Student's t test.…”

Obesity Associated with Hypertension or Hyperlipidemia Accelerates Renal Damage

“…Apart from obesity and child renal disease, glomerular hypertrophy is also often seen in cases of hypertension, FSGS and progressive IgAN. Microscopic examination of renal biopsies of such patients often shows cystic dilatation of the glomerular loop with loop elongation [14,[20][21][22]. It is thought that these changes result in damage to glomerular epithelial cells and subsequently lead to their adhesion to Bowman's capsule and development of segmental sclerosis [23].…”

“…It is thought that these changes result in damage to glomerular epithelial cells and subsequently lead to their adhesion to Bowman's capsule and development of segmental sclerosis [23]. We have reported that the appearance of cystic capillary expansion may be important indicators of renal prognosis in VUR [14] and IgAN [21].…”