Clinicopathologic features of infection-related glomerulonephritis with IgA deposits: a French Nationwide study
2 Service d'Anatomopathologie [CHRU Tours]
3 UGA UFRM - Université Grenoble Alpes - UFR Médecine
4 Service de néphrologie et immunologie clinique [CHRU Tours]
5 AP-HP - Hopital Saint-Louis [AP-HP]
6 Service de Néphrologie et Hémodialyse [CHU HEGP]
7 CHELTER - Role of intra-Clonal Heterogeneity and Leukemic environment in ThErapy Resistance of chronic leukemias
8 Service Néphrologie, Hémodialyses [CHU Clermont-Ferrand]
9 RIGHT - Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098)
10 Service de Néphrologie [CHRU Besançon]
11 CHU Angers - Centre Hospitalier Universitaire d'Angers
12 Service de néphrologie [Rennes]
13 UBO EPE - Université de Brest
14 GGB - Génétique, génomique fonctionnelle et biotechnologies (UMR 1078)
15 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
16 UPCité - Université Paris Cité
17 HEGP - Hôpital Européen Georges Pompidou [APHP]
18 CHU Clermont-Ferrand
19 Service d'Anatomie pathologique [CHRU Besançon]
20 CHU Tenon [AP-HP]
21 CoRaKID - CoRaKiD - Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
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Résumé
Abstract Background Infection-related glomerulonephritis with IgA deposits (IRGN-IgA) is a rare disease but it is increasingly reported in the literature. Data regarding epidemiology and outcome are lacking, especially in Europe. We aimed to assess the clinical, pathologic and outcome data of IRGN-IgA. Methods Clinical and outcome data from patients from 11 French centers over the 2007–2017 period were collected retrospectively. We reviewed pathologic patterns and immunofluorescence of renal biopsies and evaluated C4d expression in IRGN-IgA. We analyzed the correlation between histological presentation and outcome. Results Twenty-seven patients (23 men, mean age: 62 ± 15 years) were included. Twenty-one (78%) had Staphylococcus aureus infection and twelve (44%) were diabetic. At the time of biopsy, 95.2% had haematuria, 48.1% had a serum creatinine level of > 4 mg/dL, and 16% had hypocomplementemia. The most common pathologic presentation included mesangial (88.9%) and endocapillary proliferative glomerulonephritis (88.9%) with interstitial fibrosis and tubular atrophy (IF/TA) (85.1%). Diffuse and global glomerular C4d expression was found in 17.8%, mostly in biopsies with acute or subacute patterns, and was associated with a short delay between infection and renal biopsy compared to segmental and focal staining. After median follow-up of 13.2 months, 23.1% died, 46.2% had persistent renal dysfunction and 15.4% reached end-stage renal disease. Renal outcome was correlated to IF/TA severity. Conclusions Infection-related glomerulonephritis with IgA deposits is usually associated with Staphylococcus infections and mainly affects adult men. This entity has a poor prognosis which is correlated to interstitial fibrosis and tubular atrophy severity.