Clinico-pathological study of IgA nephropathy with nephrotic syndrome

Abstract

This study was performed to clarify the clinical features and the histopathological findings in IgA nephropathy with nephrotic syndrome. The results were as follows: 1) The nephrotic syndrome was observed in nine (4.8%) out of 187 patients with IgA nephropathy. 2) They were classified into 2 groups: (1) minor glomerular abnormalities (Minor group) = 3 cases, (2) diffuse mesangial glomerulonephritis (DPGN group) =6 cases 3) All of Minor group were normotensive and had no hematuria. All of DPGN group were associated with hematuria and two cases had hypertesion. Serum IgA was elevated in all of Minor group and three in six cases of DPGN group. 4) In immunofluorescence study, C3 was present weakly (less than 1+) in Minor group but strongly (more than 2+) in DPGN group. We thought that degree of C3 deposition was related to that of histological change. IgG was present only in one out of 9 cases. The frequency of IgG deposits was lower than that of IgA nephropathy without nephrotic syndrome. 5) All of Minor group were good responders to corticosteroid pulse therapy and came into complete remission. In contrast, DPGN group (especially more than moderate change) had poor prognosis and fell into hemodyalysis relatively soon. 6) In conclusion, our results showed that the nephrotic syndrom associated with minor glomerular abnormalities in IgA nephropathy was similar to lipoid nephrosis and different from DPGN group in the response to steroid therapy and the clinical course.