IgA Deposition 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: Diabetes mellitus (DM) is the most common cause of end-stage renal disease in the USA and is becoming an epidemic. Recent papers have defined IgA dominant infection-associated glomerulonephritis (GN) in DM however, little is published on the scope and prognosis of IgA dominant/co-dominant deposition in patients with diabetic nephropathy (DN).
Design: Our database was searched from 2001 thru 2011 for patients diagnosed with DN and IgA dominant/co-dominant deposition. The biopsies were received from multiple medical centers across the USA and showed a fair representation of all nephrology practice settings. A total of 132 consecutive cases were included. Cases were viewed by two renal pathologists.
Results: The mean age was 59 years with a 2:1 male to female ratio. Indication for biopsy was often multiple with rapid onset proteinuria/nephrotic syndrome (67%), acute renal failure (37%), and hematuria (17%) being the most common. 36/132 patients had a known history of recent infection, with osteomyelitis, foot ulcer, and cellulitis being the most common. A subset of patients showed endocapillary or crescentic proliferative GN (39/132 patients). Classification of DN via Tervaert et al showed 102/132 class III. IgA dominant/co-dominant staining was present in all patients, usually at ≥2+ intensity (81%). IgM (27%) and IgG (11%) staining was less common and C3 staining was present in 70% of patients, most commonly at ≥2+ levels. Light chains were often lambda predominant (61%) or equal intensity for kappa and lambda (26%). By electron microscopy 99% of patients displayed mesangial deposits with only 16% of patients showing capillary wall deposits. Currently, follow-up data is available for 46/132 patients (mean 45 months) showing 57% of patients have progressed to renal replacement therapy (RRT) or death. Progression to RRT or death among patients with proliferative GN (57%) and without (57%) was the same.
Conclusions: To our knowledge this is the largest series to investigate IgA dominant/co-dominant deposition in DN. In our series, DN with IgA dominant/co-dominant deposition was not uniformly associated with an underlying infection or proliferative GN. Also, prognosis was the same in patients with and without proliferative GN. This data suggests that while IgA dominant/co-dominant deposition in the setting of DN may have several different etiologies, prognosis is universally guarded.
Category: Kidney (does not include tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 238, Monday Afternoon