IgA NEPHROPATHY � ITS SEASONAL VARIATION AND CLINICO PATHOLOGICAL PROFILE IN LOCAL PATIENTS

IgA Nephropathy

Abstract

Objective: To study the frequency of IgA nephropathy in relation to seasonal variation and its clinicopathological profile at Military Hospital Rawalpindi.
Study Design: A descriptive study.
Place and Duration of Study: Military Hospital, Rawalpindi, Pakistan from Jan 2010 to Mar 2012
Patients and Methods: The study was conducted at Military Hospital Rawalpindi on 289 consecutive renal biopsy specimens. Ultrasound guided percutaneous renal biopsies were carried out in patients with the following findings: 1) Proteinuria > 1000 mg/day in adults, 2) Isolated glomerular haematuria with proteinuria 500 – 1000 mg/day, 3) Proteinuria < 500 mg/day with impaired renal functions, 4) Steroid resistant nephrotic syndrome in children. Light microscopy after Haematoxylin & Eosin, PAS and Silver stains was employed for diagnosis on formaline fixed tissue, while diagnosis of IgA nephropathy was established upon findings of characteristic IgA deposits on immunofluorescence studies on a separate core of unfixed tissue.
Results: A total of 289 renal biopsies were performed, out of which 45 were diagnosed with IgA nephropathy indicating a frequency of 15.5 %.The most common mode of clinical presentation was asymptomatic microscopic haematuria with proteinuria 500 – 1000 mg per day in 14 patients (31%). The most common histopathological finding was mesangial proliferation and hypercellularity in 15 biopsies (43%). Deposition of IgA with IgM and C3 complement was the most frequent finding on immunofluorescence in 37 biopsies (82.2%). About 80% of patients with IgA nephropathy presented in relatively colder months starting from Jan – Mar and from Sep – Dec.
Conclusion: IgA nephropathy is one of the most frequent diagnoses on renal biopsies. It usually presents in young male adults in the age range of 21–30 years with most common clinical presentation being asymptomatic microscopic haematuria. The most common pathological finding was mesangial proliferation and hypercellularity with deposition of IgA with IgM and C3 complement. Presentation of patients in colder months is possibly related to upper respiratory tract infections.