Immunoglobulin-A distribution in glomerular disease: Analysis of immunofluorescence localization and pathogenetic significance

Immunoglobulin-A distribution in glomerular disease. Analysis of immunofluorescence localization and pathogenetic significance. Renal biopsies from 470 patients with various glomemlonephropathies were studied for patterns and frequency of glomerular bound IgA. Correlations of IgA with IgG, IgM, C3, and C4 were made. Glomerular deposits of IgA were observed in five of six cases of Henoch-Schoenlein anaphylactoid nephritis (83%), stalk proliferative glomerulonephritis (73%), lupus nephritis (60%), and focal proliferative glomerulonephritis (57 %). In addition, IgA was less frequently observed in diffuse (acute) proliferative (33%), membranoproliferative (42%), membranous (32%), focal sclerosing (25%) crescentic (26%), and chronic glomerulonephritides (23%) as well as malignant arterionephrosclerosis, amyloidosis, and a group of patients with minimal glomerular alteration and no determinable diagnosis (40%). IgA was not specifically associated with IgG or IgM in any one diagnostic category but was often present with both. Deposits containing C3 and C4 most closely paralleled those of IgG and/or IgM. Presence of IgA appeared to correlate with variable degrees of increased glomerular mesangial cellularity in “minimal”, stalk proliferative, and focal-segmental glomerular lesions. The cause and immunopathogenetic significance of mesangial or peripheral glomerular capillary localization of IgA is unknown. Though a number of apparent examples of what has been referred to as IgA-IgG nephropathy were observed in this study, this entity, characterized by mesangial deposits of IgA, IgG, and C3, could not always be specifically identified or differentiated on histopathologic criteria alone from a variety of other glomerulopathies in which variable proportions of IgA, IgG, IgM, C3, and C4 globulins were localized