A Study of Ig-A Nephropathy in Children and Adults with Chance Proteinuria and/or Hematuria

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  • Katsura Hideki
    Department of Pediatrics National Medical Center Hospital
  • Arai Mitsuko
    Department of Pediatrics National Medical Center Hospital
  • Yamaguchi Masaji
    Department of Pediatrics National Medical Center Hospital
  • Okada Masaaki
    Department of Pathology National Medical Center Hospital
  • Sugisaki Tetsuzo
    The First Department of Internal Medicine, Showa University School of Medicine
  • Shiwachi Shigeyo
    The First Department of Internal Medicine, Showa University School of Medicine
  • Ito Shogo
    The First Department of Internal Medicine, Showa University School of Medicine
  • Yonekura Masahiro
    The First Department of Internal Medicine, Showa University School of Medicine
  • Sato Shigeru
    The First Department of Internal Medicine, Showa University School of Medicine
  • Kitazawa Kozo
    The First Department of Internal Medicine, Showa University School of Medicine
  • Yamamoto Jun
    The First Department of Internal Medicine, Showa University School of Medicine

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Other Title
  • IgA腎症に関する研究
  • IgA ジンショウ ニカンスルケンキュウ ショウニ ト セイジン ノ Chan
  • ―小児と成人のChance Proteinuria and/or Hematuria―

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Abstract

Fifty nine cases (31 children and 28 adults) presenting chance proteinuria and/or hematuria were selected in this study out of 192 renal biopsy cases examined light and immunofluorescent microscopy. Fourty four cases (21 children and 23 adults) out of these 59 were diagnosed to be Ig-A nephropathy (Ig-A NP). Other 14 cases out of 15 cases showed no deposition of immuno-globulines and complements (Ig-G, Ig-M, Ig-E, Ig-D, C3 and Clq), while the remaining 1 case re-vealed fibrin deposits along glomerular capillary loops. The levels of serum Ig-A in those with Ig-A NP ranged between 92-880 mg/dl, with the mean value 275.2 mg/dl. On the other hand, those without Ig-A deposit ranged between 150-430 mg/dl, with the mean value 223.0 mg/dl. Of the 44 cases with Ig-A NP (7-60 yrs. average age: 19 yrs.), 21 cases (15 children and 6 adults) showed Ig-A deposition alone in the mesangial area. The other 23 cases (6 children and 17 adults) exhibited mesangial Ig-A deposition accompanied with Ig-G and/or C3. It is posturated that Ig-A NP accompanied with the glomerular deposition of other immunoglobulins and C-components tends to be much more frequent in adults than in children. Regarding to histopathological findings, minimal change (MC) or focal prolif erative glomerulonephritis (FPGN) were often seen in children, whereas generalized prolif erative glomerulonephritis (GPGN) were more commonly seen in adults. Although the common features of the clinical findings were microscopic hematuria, the proteinuria were also identified in 27 cases (7 children and 20 adults). GPGN was commonly observed as com-pared to MC or FPGN in those who presented proteinuria in addition to microhematuria. Although Ccr determinations at biopsy were within normal range in the majority of our Ig-A NP cases, 2 cases out of 44 cases followed up showed the decrease in Ccr levels. Those evidences suggest that although Ig-A NP has a very prolonged clinical course but is not always a benign evolution.

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