Abstract
Overlapping idiopathic membranous nephropathy (IMN) and immunoglobulin A nephropathy (IgAN) is rare. This study aims to investigate the unique prognostic, clinical, and renal histopathological characteristics of IMN+IgAN. This retrospective observational study included 73 consecutive cases of IMN+IgAN and 425 cases of IMN treated between September 2006 and November 2015. Prognostic and baseline clinical and histopathological data were compared between the two patient groups. Poor prognostic events included a permanent 50% reduction in eGFR, end-stage renal disease, and all-cause mortality. Renal histopathology demonstrated that the patients with IMN+IgAN presented with significantly increased mesangial cell proliferation and matrix expansion, increased inflammatory cell infiltration, and higher proportions of arteriole hyalinosis and lesions than the patients with IMN (all P < 0.05). Kaplan–Meier analysis showed that the patients with IMN+IgAN had significantly higher cumulative incidence rates of partial or complete remission (PR or CR, P = 0.0085). Multivariate Cox model analysis revealed that old age at biopsy and high baseline serum creatinine and uric acid levels were significantly associated with poor prognosis (all P < 0.05), and increased IgA expression correlated significantly with PR or CR (P < 0.05). The present study found that overlapping IMN and IgAN presents with unique renal histopathology and appears not to cause a poorer prognosis than IMN.
Highlights
Membranous nephropathy (MN), an autoimmune glomerular disease with a characteristic renal histopathology of immunoglobulin deposition along the extracapillary side of the glomerular basement membrane, is one of the most common causes for nephrotic syndrome in adults[1,2,3,4,5,6]
The pathology of the patients’ renal biopsies was characterized by (1) thickened glomerular capillary walls revealed by hematoxylin and eosin (H&E), periodic acid-Schiff (PAS), periodic acid silver methenamine (PASM), and Masson trichrome (Masson) staining; (2) positive IgG and C3 immunofluorescence staining along the capillary walls; and (3) subepithelial deposits and fusion in podocyte structure revealed by electron microscopy[16]
A total of 506 patients with idiopathic MN identified from the consecutive renal biopsy cases from September 11, 2006 to November 25, 2015 at The First Affiliate Hospital of Wenzhou Medical University were included in this retrospective study
Summary
Membranous nephropathy (MN), an autoimmune glomerular disease with a characteristic renal histopathology of immunoglobulin deposition along the extracapillary side of the glomerular basement membrane, is one of the most common causes for nephrotic syndrome in adults[1,2,3,4,5,6]. 75% of patients with MN have idiopathic or primary membranous nephropathy (IMN), and the remaining 25% of cases are associated with various secondary causes[3, 6]. Immunoglobulin A nephropathy (IgAN), known as Berger’s disease, is the most common primary glomerulonephritis, which is characterized by dominant or codominant IgA mesangial deposition[10, 11]. Both IMN and IgAN are common primary glomerular diseases, coexisting MN and IgAN in adults is very rare[12,13,14]. We further examined the follow-up clinical data and compared the prognosis and outcomes of overlapping IMN and IgAN versus IMN only
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