Glomerular tip adhesions predict the progression of IgA nephropathy

Abstract

BackgroundFocal segmental glomerulosclerosis-like lesions have been proposed to be predictive factors for IgA nephropathy. This single center, retrospective cohort study was designed to clarify which clinical and pathological factors are predictive of decreased estimated glomerular filtration rate (eGFR) at 5 and 10 years in IgA nephropathy patients.MethodsOf the 229 patients with IgA nephropathy who were admitted to Aichi Medical University Hospital between 1986 and 2010, 57 were included in this study during the 5 to 10 years after renal biopsy. Clinical, laboratory, and pathological parameters were analyzed by multiple linear regression analysis with backward elimination to determine independent risk factors. After identifying such factors, we compared patients with and without each factor using the Student’s t test, Wilcoxon test, or Mann–Whitney U test.ResultsFour variables were identified as predictive factors for progression of IgA nephropathy: initial eGFR (p = 0.0002), glomerular tip adhesion (p = 0.004), global sclerosis (p = 0.019), and diastolic blood pressure (p = 0.024). The annual decrease in eGFR of patients with (n = 9) or without glomerular tip adhesions (n = 48) was 4.13 ± 3.58 and 1.49 ± 2.89 ml/min/1.73 m2, respectively (p = 0.015). Serum total cholesterol levels were 231 ± 45 mg/dl and 196 ± 42 mg/dl, respectively (two-sided p = 0.064; one-sided p = 0.032).ConclusionsThe presence of glomerular tip adhesions predicts the progression of IgA nephropathy. High levels of serum total cholesterol may affect glomerular tip adhesions.

Development of angiogenic periglomerular microvessels after acute glomerular lesions in IgA nephropathy

“…The development of segmental glomerulosclerosis is also considered to be a scar lesion after severe glomerular capillary injury, although primary podocytopathy and focal segmental glomerulosclerosis have recently been the focus of IgA nephropathy. 5,18,19 On the other hand, adherent PGMV is accompanied by small segmental sclerotic lesions, but not segmental sclerosis with matrix accumulation and can sometimes be connected to isolated PGMVs in serial sections. In this study, isolated PGMVs accounted for 21.4% of the PGMVs and were inherently adherent or polar PGMVs, which might be the result of the 2D limitation of light microscopic specimens.…”

“…Among them, the common types are (a) segmental glomerulosclerosis; and (b) small adhesive lesions. The development of segmental glomerulosclerosis is also considered to be a scar lesion after severe glomerular capillary injury, although primary podocytopathy and focal segmental glomerulosclerosis have recently been the focus of IgA nephropathy 5,18,19 . On the other hand, adherent PGMV is accompanied by small segmental sclerotic lesions, but not segmental sclerosis with matrix accumulation and can sometimes be connected to isolated PGMVs in serial sections.…”