Hepatic glomerulonephritis. Characteristics of hepatic IgA glomerulonephritis as the major part.

Glomerular lesions associated with hepatic disease were evaluated. Among 752 consecutive patients with hepatitis and cirrhosis, nephritic urinary changes appeared in 1.0% of chronic hepatitis and 9.2% of cirrhotics, but none in patients with acute or subacute hepatitis. Kidney tissue was obtained from 141 cases, of which 59 underwent immunofluorescent studies. Except for a few with possibly coincidental glomerulonephritis, the main glomerular pathology was mesangial depositive or proliferative lesions with frequent circumferential mesangial interposition. The highest incidence (up to 69.2%) occurred in liver cirrhosis. The glomerular immunohistology was not necessarily homogeneous. In acute or subacute hepatitis, IgG or IgM, if present, was dominant. The more chronic the course the liver disease followed, the more frequently significant IgA deposition emerged, occurring in 60.5% of cirrhotics. The IgA positive cases often disclosed paramesangial dense deposits, which is one of the characteristics of primary IgA nephritis. Hepatic IgA nephritis exhibited a lower nephritogenicity and a proneness to show mesangial interposition when compared with primary or purpuric IgA nephritis. The possible origin of glomerular IgA associated with liver disease is discussed.