Significance of vasculopathy in IgA nephropathy patients with regard to Oxford classification and immunostaining findings: a single center experience

Abstract

Introduction: immunoglobulin A nephropathy is the most common primary glomerulonephritis around the world. It remains poorly understood whether vascular pathology plays an important role in the progression of IgAN.Objectives: Since very few studies regarding vascular disorders in IgAN are published, we aimed to evaluate the role of vascular disease in a group of IgAN patients, especially with regard to Oxford classification, immunostaining findings and various laboratory and clinical data.Patients and Methods: The study was conducted from July 2009 to March 2013. All kidney biopsies were prepared for light and immunofluorescence microscopy.Results: Of the 136 patients, 94 (69%) were male. Of the 136 kidney biopsies, 37 patients had crescents, 2 had lesions of thrombotic microangiopathy (TMA), 10 had fibrinoid necrosis and one patient had morphologic lesions of small vessel vasculitis (with negative ANCA). In this study, there was no significant difference in scores of arteriolosclerosis and intimal fibrosis between males and females. There was a significant correlation between scores of arteriolosclerosis with serum creatinine. This correlation for scores of intimal fibrosis of interlobular artery was also significantly positive. The correlation of arteriolosclerosis with amount of proteinuria was significantly positive too.Conclusion: The association of vasculopathy with serum creatinine and amount of proteinuria further support the role of vasculopathy in aggravation of IgAN. We also had different results with regard to the prevalence of TMA in previous published studies, which needs further investigation in larger series of IgAN patients.

Keywords: Immunoglobulin A nephropathy, Oxford classification, Vasculopathy