Abstract
BackgroundMembranous nephropathy (MN) and immunoglobulin A nephropathy (IgAN) are although two different entities, yet can rarely coexist. There is not much data available on this coexistent disorder, specifically with regard to the treatment modality and outcome. Here, we analyse in detail, retrospectively, 13 cases of coexistent IgA and membranous nephropathy (IgA-MN).MethodsRenal biopsy data of 1084 diagnosed cases of either membranous or IgA nephropathy was obtained from March 2015 till March 2021. Out of 1084 patients, 19 diagnosed cases of the coexistent disorder were identified. Six out of 19 patients were excluded because of their unwillingness. From remaining 13 patients, data regarding clinical presentation, investigations, management and treatment response was collected from hospital database, files and via telephonic interview.ResultsThe overall prevalence noted was 1.75%. Among them, 53.8% were females and 46.2% were males. Their median age was 40 years (range: 14-71 years). On workup, mean serum albumin was 2.64 g/dl (range: 1.6-3.8 g/dl), mean proteinuria was 5.5 g/24 hours (range: 1.55-11.48 g/24 hours) and mean creatinine was 0.98 mg/dl (range: 0.5-2.8 mg/dl). Anti-phospholipase A2 receptor antibody positivity was only 14.2%. The renal biopsy of all patients showed thickening of the glomerular basement membrane with granular IgG deposits and mesangial expansion with granular IgA deposits. A total of 80% patients showed complete remission with steroids, calcineurin inhibitors (CNIs) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs).ConclusionIgA-MN is probably a separate disorder that can only be confirmed on immunofluorescence microscopy. The response to the combination of steroids, CNIs and ACEi/ARBs is found to be the most effective; hence, this combination must often be used for the management of this coexistent disorder.
Highlights
We analyse in detail, retrospectively, 13 cases of coexistent IgA and membranous nephropathy (IgA-Membranous nephropathy (MN))
Immunoglobulin A nephropathy (IgAN) and membranous nephropathy (MN) are two separate immunecomplex-mediated glomerular disorders that are characterized by different clinical manifestations, pathogenic mechanisms and histopathological findings and are managed in accordance with different treatment guidelines
The serum PLA2R antibody positivity rate was lower in concurrent MN-immunoglobulin A nephropathy (IgAN) patients
Summary
Immunoglobulin A nephropathy (IgAN) and membranous nephropathy (MN) are two separate immunecomplex-mediated glomerular disorders that are characterized by different clinical manifestations, pathogenic mechanisms and histopathological findings and are managed in accordance with different treatment guidelines. The prevalence of coexistent IgA and membranous nephropathy (IgA-MN) is very rare, yet, it has been suggested that this disorder is more common in the Chinese population [1]. IgAN is the most common glomerular disorder worldwide [2,3,4] It usually presents with asymptomatic hematuria, sub-nephrotic proteinuria, hypertension and renal impairment in later stages. It is diagnosed on histopathology and immunofluorescence by characteristic IgA deposits in glomerular mesangium. We analyse in detail, retrospectively, 13 cases of coexistent IgA and membranous nephropathy (IgA-MN)
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