Ritsuko Katafuchi1,2, Hiroshi Nagae3, Kosuke Masutani4, Toshiaki Nakano5, Mikio Munakata5,6, Kazuhiko Tsuruya7, Koji Mitsuiki6. 1. Kidney Unit, National Hospital Organization, Fukuoka-Higashi Medical Center, Fukuoka, Japan. rkatafuchi@jcom.home.ne.jp. 2. Division of Nephrology, Medical Corporation Houshikai, Kano Hospital, 1-2-1, Chuoekimae, Shingu-machi, Kasuya-gun, Fukuoka, 811-0120, Japan. rkatafuchi@jcom.home.ne.jp. 3. Kidney Unit, National Hospital Organization, Fukuoka-Higashi Medical Center, Fukuoka, Japan. 4. Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 5. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 6. Kidney Unit, Fukuoka Red Cross Hospital, Fukuoka, Japan. 7. Department of Nephrology, Nara Medical University, Nara, Japan.
Abstract
BACKGROUND: Clinicopathological significance of light chain deposition in IgA nephropathy and the relation of monotypic IgA deposition to bone marrow abnormalities are important issues to be clarified. METHODS: We retrospectively investigated light chain deposition in 526 patients with IgA nephropathy. We divided the patients into 5 groups according to the balance of intensity of both light chain deposition: lambda monotypic, lambda dominant, polytypic, kappa dominant and kappa monotypic. Clinicopathological parameters were compared among the groups. The relation of monotypic IgA deposition to hematological malignancy was also evaluated. RESULTS: The prevalence of monotypic IgA deposition was 6.3%, 33 patients (21 lambda and 12 kappa). Thirty-two (4.0%) and 10 patients (1.9%) were classified into lambda and kappa dominant groups, respectively. Polytypic IgA deposition was observed in 455 patients (85.7%). Age of onset, age at biopsy, urinary protein creatinine ratio, the percentage of global glomerulosclerosis, and the degree of IgA and C3 deposition were different among the groups. However, there was no gradual difference according to the groups. No patient with monotypic IgA deposition showed hematological abnormality at biopsy and during follow-up. CONCLUSIONS: The prevalence of IgA monotypic deposition was extremely low. Clinicopathologically, we could not differentiate patients with monotypic IgA deposition from those with polytypic one and no hematological disorder was documented in patients with monotypic IgA deposition. Whether IgA nephropathy with monotypic IgA deposition and that with polytypic one is the same entity or not, and relation between monotypic IgA deposition and hematological malignancy should be clarified by further investigations.
BACKGROUND: Clinicopathological significance of light chain deposition in IgA nephropathy and the relation of monotypic IgA deposition to bone marrow abnormalities are important issues to be clarified. METHODS: We retrospectively investigated light chain deposition in 526 patients with IgA nephropathy. We divided the patients into 5 groups according to the balance of intensity of both light chain deposition: lambda monotypic, lambda dominant, polytypic, kappa dominant and kappa monotypic. Clinicopathological parameters were compared among the groups. The relation of monotypic IgA deposition to hematological malignancy was also evaluated. RESULTS: The prevalence of monotypic IgA deposition was 6.3%, 33 patients (21 lambda and 12 kappa). Thirty-two (4.0%) and 10 patients (1.9%) were classified into lambda and kappa dominant groups, respectively. Polytypic IgA deposition was observed in 455 patients (85.7%). Age of onset, age at biopsy, urinary protein creatinine ratio, the percentage of global glomerulosclerosis, and the degree of IgA and C3 deposition were different among the groups. However, there was no gradual difference according to the groups. No patient with monotypic IgA deposition showed hematological abnormality at biopsy and during follow-up. CONCLUSIONS: The prevalence of IgA monotypic deposition was extremely low. Clinicopathologically, we could not differentiate patients with monotypic IgA deposition from those with polytypic one and no hematological disorder was documented in patients with monotypic IgA deposition. Whether IgA nephropathy with monotypic IgA deposition and that with polytypic one is the same entity or not, and relation between monotypic IgA deposition and hematological malignancy should be clarified by further investigations.
Entities:
Keywords:
Hematological disorder; IgA nephropathy; Light chain; Monotypic IgA deposition
Authors: Samih H Nasr; Glen S Markowitz; M Barry Stokes; Surya V Seshan; Elsa Valderrama; Gerald B Appel; Pierre Aucouturier; Vivette D D'Agati Journal: Kidney Int Date: 2004-01 Impact factor: 10.612
Authors: Samih H Nasr; Anjali Satoskar; Glen S Markowitz; Anthony M Valeri; Gerald B Appel; Michael B Stokes; Tibor Nadasdy; Vivette D D'Agati Journal: J Am Soc Nephrol Date: 2009-05-21 Impact factor: 10.121