IgM_Nephropathy - IgMNephropathy 11/29/2011 JunKiPark

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IgM Nephropathy 11/29/2011 Jun Ki Park
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First described by Cohen, Border et al. in 1978, in a series of 12 cases whose initial native renal biopsy specimens displayed: mild glomerular mesangial hypercellularity on light microscopy Diffuse granular mesangial IgM and C3 deposition on IF EM showed generalized foot process effacement; mesangial electron dense deposits were seen in ~50% of the patients. Excluded those that showed focal sclerosis, those with systemic disease such as lupus or vasculitis. Critical distinction between IgM mesangial nephropathy and MCD is poor response rate to steroid therapy.
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Light microscopy usually indicates diffuse proliferation of mesangial cells and accumulation of extracellular mesangial matrix Diffuse, granular, mesangial deposition of IgM, often is associated with complement, especially C3 EM shows generalized foot process effacement and mesangial electron dense deposits
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Failure to identify IgM nephropathy as a distinct clinicopathological entity thus far may have resulted from failure to adhere to strict pathological criteria. Other series of patients with ‘IgM nephropathy’ have included patients with FSGS (O’Donoghue et al. QJM 1991) and normal glomeruli by light microscopy (Myllymaeki et al. AJKD 2003) on initial biopsy. Its extreme forms resemble MCD and FSGS
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Is IgM Nephropathy a distinct disease entity? Pro… Border et al. KI 1988
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Is IgM Nephropathy a distinct disease entity? Pro Border et al. KI 1988
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Is IgM Nephropathy a distinct disease entity? Pro… Recurrent IgM nephropathy in renal allograft. Solomon et al. 1981 : recurrence in 3 weeks after Tx Myllymaeki et al. 2003 : included normal glomeruli by light microscopy Salmon et al. NDT 2004 : Recurrent diffuse, granular mesangial deposition, with increased mesangial matrix and cellularity in the allograft, 4 yrs after Tx.
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Is IgM Nephropathy a distinct disease entity? Contra… Many investigators report its presence in the context of MCD, MH and FSGS, rather than as a distinct pathological entity (Vilches et al Lab Invest 1982; Ji Yun et al. KI 1984; Pardo et al. AJKD 1984; Lool et al. Pathology 1985. .) Other cases show IgM on IF (often segmental rather than diffuse)
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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IgM_Nephropathy - IgMNephropathy 11/29/2011 JunKiPark

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