Abstract
Introduction: Immunoglobulin A (IgA) nephropathy is the commonest primary glomerulonephritis with a wide range of clinical presentations and laboratory findings. There is a paucity of studies regarding the significance of co-dominant immunoglobulin G (IgG) deposition in IgA nephropathy.Methods: The study included retrospective and prospective biopsy-proven cases of IgA nephropathy from 2013-2020 with a minimum of eight glomeruli. Clinical and laboratory parameters were analysed for the IgA and IgG co-dominant cases as compared to those of the non-IgG group.Results: A total of 58 cases of IgA nephropathy were included in the study out of which 25 biopsies (43.1%) were categorized as IgA plus IgG, and the rest 33 biopsies (56.8%) as the non-IgG group. A significant correlation was noted amongst the IgA plus IgG group with respect to the elevated mean arterial pressure (MAP) (p=0.038) and proteinuria (p=0.002) as compared to the non-IgG group. Amongst the MEST-C (mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, tubular atrophy/interstitial fibrosis, crescents) variables, endocapillary hypercellularity correlated with elevated MAP (p=0.04), raised serum creatinine (p=0.005), and decreased estimated glomerular filtration rate (eGFR) (p=0.002).Conclusion: Co-dominant IgG deposit serves as an adverse marker pointing towards a deranged renal function in IgA nephropathy.
Highlights
Immunoglobulin A (IgA) nephropathy is the commonest primary glomerulonephritis with a wide range of clinical presentations and laboratory findings
Immunoglobulin A (IgA) nephropathy characterized by the presence of dominant or co-dominant mesangial IgA immune deposits, often accompanied by complement component 3 (C3) and immunoglobulin G (IgG) in association with proliferative glomerulonephritis of varying severity, was first described by Berger and Hinglais in 1968 [1,2]
The new Oxford MEST-C scoring system 2016 does not include immunostains, the location of glomerular IgA along with IgG immune deposits demonstrated by immunofluorescence studies correlates with mesangial and endocapillary hypercellularity, which according to the new MEST-C score are strong prognostic indicators in IgA nephropathy patients [4]
Summary
Immunoglobulin A (IgA) nephropathy is the commonest primary glomerulonephritis with a wide range of clinical presentations and laboratory findings. There is a paucity of studies regarding the significance of co-dominant immunoglobulin G (IgG) deposition in IgA nephropathy. Immunoglobulin A (IgA) nephropathy characterized by the presence of dominant or co-dominant mesangial IgA immune deposits, often accompanied by complement component 3 (C3) and immunoglobulin G (IgG) in association with proliferative glomerulonephritis of varying severity, was first described by Berger and Hinglais in 1968 [1,2]. Nowadays, it has assumed increasing importance with more and more cases being diagnosed with the advent of immunofluorescence. Animal model studies have demonstrated that mesangial IgG deposition was associated with greater inflammation [5]
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