BACKGROUND: Proteinuria is an uncommon clinical manifestation of IgA nephropathy and is usually seen in cases with severe lesions like endocapillary proliferation. However, it is occasionally seen even with cases with mild glomerular manifestations and may even be of nephrotic range. PREDICTOR: Podocyte foot process effacement. OUTCOME: Severity of proteinuria. MEASUREMENTS: Podocyte foot process effacement was measured. Morphometric analysis was performed on transmission electron microscope images using a computerized digital photomicrograph system (BioWizard 4.2 Image analysis software, New Delhi, India). Proteinuria was measured quantitatively assigned into five grades. RESULTS: It was found that as the extent of proteinuria increased, the effacement ratio also increased, and this was most significant between "no" proteinuria and the rest of the categories. CONCLUSION: Nephrotic presentation in IgA nephropathy is a known phenomenon and in certain cases may show near normal glomerular morphology with severe foot process effacement on EM being the only significant finding to explain the proteinuria. Proteinuria in these cases shows a significant correlation with degree of foot process effacement. Renal biopsy is important in these cases because they are known to have a better prognosis and are usually steroid responsive.
BACKGROUND:Proteinuria is an uncommon clinical manifestation of IgA nephropathy and is usually seen in cases with severe lesions like endocapillary proliferation. However, it is occasionally seen even with cases with mild glomerular manifestations and may even be of nephrotic range. PREDICTOR: Podocyte foot process effacement. OUTCOME: Severity of proteinuria. MEASUREMENTS: Podocyte foot process effacement was measured. Morphometric analysis was performed on transmission electron microscope images using a computerized digital photomicrograph system (BioWizard 4.2 Image analysis software, New Delhi, India). Proteinuria was measured quantitatively assigned into five grades. RESULTS: It was found that as the extent of proteinuria increased, the effacement ratio also increased, and this was most significant between "no" proteinuria and the rest of the categories. CONCLUSION:Nephrotic presentation in IgA nephropathy is a known phenomenon and in certain cases may show near normal glomerular morphology with severe foot process effacement on EM being the only significant finding to explain the proteinuria. Proteinuria in these cases shows a significant correlation with degree of foot process effacement. Renal biopsy is important in these cases because they are known to have a better prognosis and are usually steroid responsive.
Entities:
Keywords:
Foot process effacement; IgA nephropathy; proteinuria
Authors: Anna Pisarek-Horowitz; Xueping Fan; Sudhir Kumar; Hila M Rasouly; Richa Sharma; Hui Chen; Kathryn Coser; Crystal T Bluette; Dinesh Hirenallur-Shanthappa; Sarah R Anderson; Hongying Yang; Laurence H Beck; Ramon G Bonegio; Joel M Henderson; Stephen P Berasi; David J Salant; Weining Lu Journal: Am J Pathol Date: 2020-03-24 Impact factor: 4.307
Authors: Crislaine Aparecida da Silva; Maria Luíza Gonçalves Dos Reis Monteiro; Liliane Silvano Araújo; Monise Gini Urzedo; Lenaldo Branco Rocha; Marlene Antônia Dos Reis; Juliana Reis Machado Journal: PLoS One Date: 2020-11-04 Impact factor: 3.240