Histopathological Comparison of Idiopathic and Secondary IgA Nephropathy Associated with Liver Cirrhosis
MM Desouki, S Osaguona, SS Donna, W Fitzgibbon, JCQ Velez, S Self. MUSC, Charleston; MUSC, Charleston, SC
Background: Immunoglobulin A nephropathy (IgAN), one of the most common causes of primary glomerulonephritis, has been associated with chronic liver disease. So far, the clinical course, optimal management and frequency of IgAN associated with liver disease have not been well established. The aim of this study is to compare the histopathologic characteristics of idiopathic IgAN and that associated with chronic liver disease.
Design: We retrospectively reviewed non-transplant renal biopsy reports and slides of all IgAN cases diagnosed at our institution from 1994 to 2009 (n=57). Eight cases (14%) had IgAN associated with chronic liver disease (group 1). We compared the renal pathology [by conventional staining, immunofluorescence (IF) and electron microscopy (EM)] of group 1 with the rest of the cases with idiopathic IgAN without liver disease (n=49) (group 2). In addition, clinical and demographic parameters available from the patient charts were compared.
Results: Histological examination revealed a significant increase in mempranoproliferative changes (glomerular basement membrane double contour) in group 1. No significant difference was identified between both groups as regards activity and chronicity index and percent of focally or globally sclerotic glomeruli. IF data a revealed significant difference for C1q and no significant difference for C3, IgG, IgA, IgM, Kappa, lambda and fibrin staining. EM revealed a significant increase in reduplication of the glomerular basement membrane, foot processes effacement, subendothelial and mesangial deposits in group 1. No significant difference was noted in subepithelial deposits between the two groups. In terms of available clinical and demographic data, characteristics of the two groups were overall similar. Furthermore, serum creatinine levels at biopsy ranged from 1.2 - 8.9 in group 1. The rate of death from any cause by 6 months post biopsy was 2/8 in group 1. Liver transplantation seems to have lead to better renal function in one out of two patients underwent liver transplantation in group 1.
Conclusions: More mempranoproliferative changes were seen in IgAN associated with liver disease that idiopathic IgAN. This difference is not entirely explained by positive hepatitis C virus serology. These observations may contribute for a better understanding of the natural history of this entity and provide insights for the management of these patients.
Category: Kidney (does not include tumors)
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 236, Wednesday Afternoon