Acute Proliferative Glomerulonephritis in Diabetic Nephropathy
Larry Nicholas Cossey, Nidia Messias, Patrick D Walker, Fred G Silva. Nephropath, Little Rock, AR; University of Arkansas for Medical Sciences, Little Rock, AR
Background: Diabetic nephropathy (DN) is the most common cause of end-stage renal disease in the US and its incidence is rapidly increasing. Recent papers have defined IgA dominant infection-associated proliferative glomerulonephritis (GN) in diabetic patients and its associated poor prognosis; however few if any large series have looked at the prognosis and spectrum of proliferative GN in patients with DN.
Design: Our database was searched from 2001 thru 2011 for patients with diagnosed DN and proliferative GN (intra- or extracapillary hypercellularity). A total of 78 consecutive cases were included. All cases were viewed by at least two renal pathologists.
Results: The mean age was 59 years with a 1.5:1 male to female ratio. Indication for biopsy was often multiple with acute renal failure/elevated creatinine and rapid increase in proteinuria/nephrotic syndrome being the most common. A history of recent infection was reported in 33 patients with urinary tract infection, cellulitis and pneumonia the most common. Proliferative GN was present in all patients, often with “shredding” of the KW nodules. By immunofluorescence 39/78 patients showed IgA dominance while 17/78 and 5/78 displayed IgG and IgM dominance, respectively. Of the 33/78 patients with clinical history of infection 19/33 were IgA dominant. C3 staining was present in 71/78 patients often at ≥2+ levels. Lambda was the dominant light chain in 33/78, with 25/78 having equal lambda/kappa staining. By electron microscopy 76/78 patients displayed immune complex deposition with 69/78 showing mesangial deposits and 38/78 and 34/78 patients displaying subendothelial and subepithelial deposits, respectively. Presently, follow-up data is available for 35/78 cases (average 44 months). No significant difference in clinical outcome was identified (p=0.74) between IgA dominant and non-IgA dominant patients with 63% and 57% proceeding to renal replacement therapy or death, respectively.
Conclusions: To our knowledge, this series is the largest to date to explore the prognosis and scope of proliferative GN in DN. Follow-up data revealed a similar rate of progression to renal replacement therapy or death for IgA dominant and non-IgA dominant patients. Also, of the 33/78 patients with history of recent infection, DN, and proliferative GN, 58% displayed IgA dominant staining while 42% did not. These findings suggest that regardless of heavy-chain dominance, proliferative GN in DN has a poor clinical outcome and that infection-associated proliferative GN in DN is not restricted to the IgA dominant type.
Category: Kidney (does not include tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 241, Monday Afternoon