[Evaluation of the severity of glomerular damage in IgA nephropathy: significance of hyaline glomeruli in pattern classification].
Hyaline glomeruli are observed frequently in biopsied samples with mild to severe glomerular damage. We thus investigated whether or not all hyaline glomeruli have the same semiquantitative values in order to predict accurately the renal prognosis. We histopathologically studied 503 patients with IgA nephropathy (256 males and 247 females; mean age: 32.1 +/- 13.5 yrs), whose prognoses were followed for more than 3 yrs (mean follow-up period: 9.3 +/- 4.5 yrs). Cases with severely damaged prolifero-sclerotic glomeruli showed poor prognoses (severely damaged glomeruli: (-) vs (  renal death rate: 6% vs 52%, p < 0.0001; the 15 year-survival rate: 89% vs 52%, p < 0.0001) and hyaline glomeruli were seen in 68% of the cases. Hyaline glomeruli were observed in 29% of the cases with mild glomerular damage. However, the renal prognosis was not affected by the presence of hyaline glomeruli based on the analysis of the generalized Wilcoxon test. These results indicated that hyaline glomeruli express two different characteristics for renal prognosis. Therefore, the appearance of hyaline glomeruli alone is less important for the prediction of renal prognosis, but the appearance of both glomeruli with hyalinosis and those with severe damage was found useful in accurately predicting the renal prognosis.
Kiyoshi
Y
Y
2nd Department of Pathology, Fukuoka University School of Medicine, Japan.
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005920:Glomerular Mesangium / Q000473:pathology*; D005922:Glomerulonephritis, IGA / Q000145:classification* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index