IgA Nephropathy

• (Synonyms: Berger’s Disease, IgA GN)

• emerging as the most common for glomerulopathy
worldwide
• It is characterised by aggregates of IgA,
• deposited principally in the mesangium.
 IgA Nephropathy
• ETIOPATHOGENESIS.
• i) It is idiopathic in most cases.
• ii) Seen as part of Henoch-Schonlein purpura.
• iii) Association with chronic inflammation in various body
systems (e.g. chronic liver disease, inflammatory bowel
• disease, leprosy, dermatitis etc)
 IgA Nephropathy
• Pathogenesis:
• i) In view of exclusive mesangial deposits of IgA and elevated serum levels
of IgA and IgA-immune complexes, IgA nephropathy has been considered
to arise from entrapment of these complexes in the mesangium.
• iii) Since there is close association between mucosal infections (e.g. of the
respiratory, gastrointestinal or urinary tract), it is suggested that IgA
deposited in the mesangium could be due to increased mucosal secretion
of IgA.
• genetically-determined abnormality of the immune system producing an
increase in circulating IgA.
 IgA Nephropathy
• MORPHOLOGIC FEATURES.
• By light microscopy, the pattern of involvement varies.
• These include: focal proliferative GN, focal segmental
glomerulosclerosis, membranoproliferative GN, and rarely
RPGN.
 IgA Nephropathy
• By electron microscopy,
• finely granular electron-dense deposits are seen in the
mesangium.
• By immunofluorescence microscopy,
• demonstration of mesangial deposits of IgA, with or without
IgG, and usually with C3 and properdin.
 IgA Nephropathy
• CLINICAL FEATURES.
• children and young adults
• by recurrent bouts of haematuria that are often precipitated
by mucosal infections.
• Mild proteinuria is usually present and
• occasionally nephrotic syndrome may develop
 Chronic Glomerulonephritis
• (Synonym: End-Stage Kidney)
• Chronic GN is the final stage of a variety of glomerular diseases which
result in irreversible impairment of renal function.
 Chronic Glomerulonephritis
• The conditions which may progress to chronic GN, in descending order of
frequency, are as under:
• i) Rapidly progressive GN (90%)
• ii) Membranous GN (50%)
• iii) Membranoproliferative GN (50%)
• iv) Focal segmental glomerulosclerosis (50%)
• v) IgA nephropathy (40%)
• vi) Acute post-streptococcal GN (1%).
about 20% cases of chronic GN are idiopathic without evidence of preceding
GN of any type
 Chronic Glomerulonephritis
• MORPHOLOGIC FEATURES.
• Grossly, the kidneys are usually small and contracted weighing as low
as 50 gm each.
• The capsule is adherent to the cortex.
• The cortical surface is generally diffusely granular .
• On cut section, the cortex is narrow and atrophic,
• the medulla is unremarkable.
 Chronic Glomerulonephritis
• Microscopically, the changes vary greatly depending upon the
underlying glomerular disease.
• In general, the following changes are seen .
• i) Glomeruli—
• Glomeruli are reduced in number
• completely hyalinised tufts, giving the appearance of acellular,
eosinophilic masses.
• Evidence of underlying glomerular disease may be present.
 Chronic Glomerulonephritis
• ii) Tubules—Many tubules completely disappear and there may be
atrophy of tubules close to scarred glomeruli. Tubular cells show
hyaline-droplets, degeneration and tubular lumina frequently contain
eosinophilic, homogeneous casts.
• iii) Interstitium—There is fine and delicate fibrosis of the interstitial
tissue and chronic inflammatory cells .
• iv) Vessels—Advanced cases which are frequently associated with
hypertension show conspicuous arterial and arteriolar sclerosis.
 Chronic Glomerulonephritis
• Patients of end-stage kidney disease on dialysis show a variety of
dialysis associated changes that include
• acquired cystic disease ,
• occurrence of adenomas and
• adenocarcinomas of the kidney,
• calcification of tufts
• and deposition of calcium oxalate crystals in tubules.
 Chronic Glomerulonephritis
• CLINICAL FEATURES.
• The patients are usually adults.
• hypertension, uraemia and progressive deterioration of renal
function.
• These patients eventually die if they do not receive a renal transplant.
Chronic Glomerulonephritis
Chronic Glomerulonephritis