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Pathology of IgA nephropathy

Nature Reviews Nephrology volume 10, pages 445–454 (2014)Cite this article

Subjects

Key Points

  • IgA nephropathy is defined by the presence of IgA-dominant or co-dominant glomerular deposits

  • Glomerular changes under light microscopy are diverse, ranging from minimal abnormality to crescentic glomerulonephritis, or an appearance resembling primary focal segmental glomerulosclerosis

  • Mesangial hypercellularity, segmental glomerulosclerosis and tubular atrophy/interstitial fibrosis are of prognostic value and predict renal outcomes independent of clinical variables

  • Evidence from retrospective clinicopathological studies indicates that endocapillary hypercellularity and cellular crescents are responsive to steroid and/or immunosuppressive therapy

  • Prospective data from randomized control trials are required to determine how histopathology should be used to guide therapy

Abstract

IgA nephropathy is defined by the presence of IgA-dominant or co-dominant immune deposits within glomeruli. Biopsy specimens meeting these diagnostic criteria have a range of histological changes that are reflected in the variable clinical course of IgA nephropathy. The impact of histology on outcomes in IgA nephropathy has been clarified in a number of large retrospective clinicopathological studies. These studies have consistently demonstrated that the stage of disease at presentation, as indicated by the extent of interstitial fibrosis and tubular atrophy in the biopsy, is the strongest histological predictor of renal survival. The effect of active proliferative lesions on the disease course is less clear cut, owing in part to considerable treatment bias in most published retrospective studies. There is evidence that endocapillary hypercellularity and cellular crescents are responsive to immunosuppressive therapy, but this observation requires confirmation in prospective randomized controlled trials. Future challenges include improving the reproducibility of histological scoring, particularly for the presence and extent of endocapillary lesions, and to improve prognostic modelling by combining histological data with clinical variables and biomarker data.

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Figure 1: Immunohistological and histological changes in IgA nephropathy.

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  1. Department of Cellular Pathology, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, UK

    Ian S. D. Roberts

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Roberts, I. Pathology of IgA nephropathy. Nat Rev Nephrol 10, 445–454 (2014). https://doi.org/10.1038/nrneph.2014.92

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