Hong Kong Journal of Nephrology
Volume 10, Issue 2 , Pages 50-57, October 2008

“Journey to the West”: Fact and Fiction. On the Chronicity-based Grading of IgA Nephropathy Model and Thick GCBM as Marker for a Syndrome

The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR

Article Outline

The pathological diagnosis of IgA nephropathy is straightforward and based on the distinctive mesangial deposition of dominant IgA-containing immune complexes, even though the pathogenesis is poorly understood and appears to be heterogeneous. The importance of clinical and morphological prognostic factors cannot be overemphasized. The chronicity-based histological grading of IgA nephropathy is stressed for its predictive impact and close correlation with the protracted course and disease progression. Extrapolation of the chronicity-base grading of IgA nephropathy to all other chronic nephritis is inferred, linking a fictional approach to the facts. The second topic describes the ongoing characterization of the isolated thick glomerular capillary basement membrane (TGCBM), which has accumulated sufficient attributes to link such a renal lesion to the metabolic syndrome. While the full significance of TGCBM remains to be investigated, as a marker of the metabolic syndrome, its recognition and diagnosis may have a preventive impact on the complications arising from the worldwide epidemic of diabetes and obesity.

Key words:  IgA nephropathy , thick glomerular capillary basement membrane

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References 

  1. Cheng EW , Jenner WJF . Journey to the West . Beijing: Foreign Language Press; 2003;
  2. Hovey Wriggins S . The Silk Road Journey with Xuanzang . Boulder, CO: Westview Press; 2003;
  3. Kieschnick J . The Impact of Buddhism on Chinese Material Culture . Princeton: Princeton University Press; 2003;
  4. Berger J , Hinglais N . Les depots intercapillaires d'IgA-IgG . J Urol Nephrol . 1968;74:694–695
  5. Berger J , Hinglais N , Striker L . Intercapillary deposits of IgA-IgG . J Am Soc Nephrol . 2000;11:1957–1959
  6. Clarkson AR , Seymour AE , Thompson AJ , Haynes WD , Chan YL , Jackson B . IgA nephropathy: a syndrome of uniform morphology, diverse clinical features and uncertain prognosis . Clin Nephrol . 1977;8:459–471
  7. Haas M . Histologic subclassification of IgA nephropathy: a clinicopathologic study of 244 cases . Am J Kidney Dis . 1997;29:829–842
  8. To KF , Choi PC , Szeto CC , Li PK , Tang NL , Leung CB , et al.   Outcome of IgA nephropathy in adults graded by chronic histological lesions . Am J Kidney Dis . 2000;35:392–400
  9. Markowitz GS , D'Agati VD . The ISN/RPS 2003 classification of lupus nephritis: an assessment at 3 years . Kidney Int . 2007;71:491–495
  10. Schwartz M . The pathology of lupus nephritis . Semin Nephrol . 2007;27:22–34
  11. Alamartine E , Sabatier JC , Berthoux FC . Comparison of pathological lesions on repeated renal biopsies in 73 patients with primary IgA glomerulonephritis: value of quantitative scoring and approach to final prognosis . Clin Nephrol . 1990;34:45–51
  12. Ibels LS , Gyory AZ . IgA nephropathy: analysis of the natural history, important factors in the progression of renal disease and review of the literature . Medicine . 1994;73:79–100
  13. Lee SM . Prognostic indicators of progressive renal disease in IgA nephropathy: emergence of a new histologic grading system . Am J Kidney Dis . 1997;29:953–958
  14. Wyatt RJ , Emancipator SN , Kon V , Waldo FB , Donadio J , Grande JP , et al.   IgA nephropathy databank: development of a system for management of renal biopsy acquired data . Am J Kidney Dis . 1997;29:817–828
  15. D'Amico G . Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome . Semin Nephrol . 2004;24:179–196
  16. Lee HS , Lee MS , Lee SM , Lee SY , Lee ES , Lee EY , et al.   Histological grading of IgA nephropathy predicting renal outcome: revisiting H. S. Lee's glomerular grading system . Nephrol Dial Transplant . 2005;20:342–348
  17. Li PK , Ho KK , Szeto CC , Yu L , Lai FMM . Prognostic indicators of IgA nephropathy in the Chinese—clinical and pathological perspectives . Nephrol Dial Transplant . 2002;17:64–69
  18. Lai FMM , Szeto CC , Choi PCL , Li PKT , Tang NLS , Chow KM , et al.   Primary IgA nephropathy with low histologic grade and disease progression: is there a “point of no return”? . Am J Kidney Dis . 2002;39:401–406
  19. Ma LJ , Fogo AB . Modulation of glomerulosclerosis . Semin Immunopathol . 2007;29:385–395
  20. Barratt J , Feehally J . IgA nephropathy . J Am Soc Nephrol . 2005;16:2088–2097
  21. Lai KN , Chan LY , Leung JC . Mechanisms of tubulointerstitial injury in IgA nephropathy . Kidney Int Suppl . 2005;94:S110–S115
  22. Gambara V , Mecca G , Remuzzi G , Bertani T . Heterogeneous nature of renal lesions in type II diabetes . J Am Soc Nephrol . 1993;3:1458–1466
  23. Manno V , Strippoli GF , D'Altri C , Torres D , Rossini M , Schena FP . A novel simpler histological classification for renal survival in IgA nephropathy: a retrospective study . Am J Kidney Dis . 2007;49:763–775
  24. Moranne O , Watier L , Rossert J , Stengel B , GN-Progress Study Group  . Primary glomerulonephritis: an update on renal survival and determinants of progression . QJM . 2008;101:215–224
  25. Lai FM , Szeto CC , Choi PC , Li PK , Chan AW , Tang NL , et al.   Characterization of early IgA nephropathy . Am J Kidney Dis . 2000;36:703–708
  26. Szeto CC , Choi PC , To KF , Li PKT , Hui J , Chow KM , et al.   Grading of acute and chronic renal lesions in Henoch-Schonlein purpura . Mod Pathol . 2001;14:635–640
  27. Troyanov S , Roasio L , Pandes M , Herzenberg AM , Cattran DC . Renal pathology in idiopathic membranous nephropathy: a new perspective . Kidney Int . 2006;69:1641–1648
  28. Lai FM , Szeto CC , Choi PC , Ho KK , Tang NL , Chow KM , et al.   Isolated diffuse thickening of glomerular capillary basement membrane: a renal lesion in prediabetes? . Mod Pathol . 2004;17:1506–1512
  29. Wong TY , Choi PC , Szeto CC , To KF , Tang NL , Chan AW , et al.   Renal outcome in type 2 diabetic patients with or without coexisting nondiabetic nephropathies . Diabetes Care . 2002;25:900–905
  30. Mazzucco G , Bertani T , Fortunato M , Fop F , Monga G . The prognostic value of renal biopsy in type 2 diabetes mellitus patients affected by diabetic glomerulosclerosis . J Nephrol . 2005;18:696–702
  31. Tanji N , Markowitz GS , Fu C , Kislinger T , Taguchi A , Pischetsrieder M , et al.   Expression of advanced glycation end products and their cellular receptor RAGE in diabetic nephropathy and nondiabetic renal disease . J Am Soc Nephrol . 2000;11:1656–1666
  32. Ziyadeh FN , Wolf G . Pathogenesis of the podocytopathy and proteinuria in diabetic glomerulopathy . Curr Diabetes Rev . 2008;4:39–45
  33. Dronavalli S , Duka I , Bakris GL . The pathogenesis of diabetic nephropathy . Nat Clin Pract Endocrinol Metab . 2008;4:444–452
  34. Cusumano AM , Bodkin NL , Hansen BC , Iotti R , Owens J , Klotman PE , et al.   Glomerular hypertrophy is associated with hyperinsulinemia and precedes overt diabetes in aging rhesus monkeys . Am J Kidney Dis . 2002;40:1075–1085
  35. Liu BC , Chen Q , Luo DD , Sun J , Phillips AO , Ruan XZ , et al.   Mechanisms of irbesartan in prevention of renal lesion in streptozotocin-induced diabetic rats . Acta Pharmacol Sin . 2003;24:67–73
  36. Wallace TM , Levy JC , Matthews DR . Use and abuse of HOMA modeling . Diabetes Care . 2004;27:1487–1495
  37. Ko GT , Chan JC , Cockram CS . The association between dyslipidemia and obesity in Chinese man after adjustment for insulin resistance . Atherosclerosis . 1998;138:153–161
  38. Peralta CA , Kurella M , Lo JC , Chertow GM . The metabolic syndrome and chronic kidney disease . Curr Opin Nephrol Hypertens . 2006;15:361–365
  39. Chen J , Gu D , Chen CS , Wu X , Hamm LL , Muntner P , et al.   Association between the metabolic syndrome and chronic kidney disease in Chinese adults . Nephrol Dial Transplant . 2007;22:1100–1106
  40. Lorenzo C , Nath SD , Hanley AJ , Abboud HE , Haffner SM . Relation of low glomerular filtration rate to metabolic disorders in individuals without diabetes and with normoalbuminuria . Clin J Am Soc Nephrol . 2008;3:783–789
  41. Derosa G , Cicero AF , D'Angelo A , Gaddi A , Ciccarelli L , Piccinni MN , et al.   Effects of 1 year of treatment with pioglitazone or rosiglitazone added to glimepiride on lipoprotein (a) and homocysteine concentrations in patients with type 2 diabetes mellitus and metabolic syndrome: a multicenter, randomized, double-blind, controlled clinical trial . Clin Ther . 2006;28:679–688

PII: S1561-5413(08)60021-6

doi:10.1016/S1561-5413(08)60021-6

Hong Kong Journal of Nephrology
Volume 10, Issue 2 , Pages 50-57, October 2008

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