MESANGIOPROLIFERATIVE GLOMERULONEPHRITIS WITH IgM DEPOSITION: CLINICAL CHARACTERISTICS AND OUTCOME

Figures & data

Table 1. Clinical features at the time of biopsy

	Presenting features
	Nephrotic syndrome (n = 22)	Asymptomatic proteinuria (n = 14)	Macroscopic hematuria (n = 10)	Isolated microscopic hematuria (n = 8)	All patients (n = 54)
Fraction of total group	41%	26%	18%	15%	100%
Mean age (range)	19.7	29.5	21.2	34.6	24.6
	(1.6–63.1)	(8.6–61.5)	(11.6–24.5)	(11.5–55.6)	(1.6–63.1)
M:F ratio	17:5	8:6	6:4	4:4	35:19
Renal function (normal/impaired^a)	21/1	14/0	10/0	8/0	53/1
Mean Serum creatinine	73.2 μM	78.8 μM	76.9 μM	74.8 μM	73.9 μM
(95% C.I.)	(52–94)	(71–86)	(66–89)	(66–85)	(68–80)
Mean Proteinuria,	5.5	0.82	0.15	0.15	0.87
g/24hrs (95% C.I.)	(3.1–9.6)	(0.4–1.2)	(0.04–0.5)	(0.1–0.2)	(0.5–1.5)
Microscopic hematuria	39%	54%	86%	100%	63.5%
Hypertension	25%	14%	0%	25%	21%

^aImpaired: Serum creatinine >120 μM.

Table 2. Pathological features on renal biopsy

	Glomeruli affected: number (%)
	0	+1	+2	+3
Mesangial proliferation	—	16 (29.6%)	35 (64.8%)	3 (5.6%)
Foot process effacement (n = 37)	30 (81.1%)	6 (16.2%)	1 (2.7%)	—
Electron-dense deposits (n = 38)	21 (55.3%)	13 (34.2%)	4 (10.5%)
IgM intensity	—	36 (67%)	16 (30%)	2 (3%)
Co-deposition of C3	33 (62%)	20 (36%)	1 (2%)	—
Tubular atrophy	42 (81%)	10 (19%)	—	—
Vascular changes	40 (77%)	10 (19%)	2 (4%)	—
Global sclerosis	44 (85%)	5 (10%)	3 (5%)	—

Table 3. Clinical features at the time of last follow up

	Nephrotic syndrome (n = 18^*)	Asymptomatic proteinuria (n = 14)	Macroscopic hematuria (n = 10)	Microscopic hematuria (n = 8)	All patients (n = 50^*)
Serum creatinine	76.9 uM^a	83.1 uM	79.1 uM	84 uM	79.9 uM^a
(95% C.I.)	(70-84)	(73-93)	(72-87)	(76-92)	(75-84)
Proteinuria: g/24 hrs	0.48^b	0.39	0.21	0.18	0.27^a
(95%C.I.)	(0.2–1.1)	(0.17–0.6)	(0.08–0.3)	(0.1–0.23)	(0.15–0.5)
Microscopic hematuria	10%	40%	57%	100%	36%
Hypertension	10.5%	11%	14%	25%	13%

^*Excluding the 4 nephrotic pts progressing to ESRF

^ap < 0.05 compared to value at the time of biopsy (Paired T-test)

^bp < 0.001 compared to value at the time of biopsy (Paired T-test).

Figure 1. Response to therapy among nephrotic patients, n = 20.

Figure 2. PAS × 200. Biopsy from a patient presenting with hematuria and low-grade proteinuria. The glomerulus shows mesangial hypercellularity and mild endocapillary proliferation.

Figure 3. Direct Immunofluorescence for IgM × 200. Diffuse mesangial positivity with some capillary loop involvement in a patient presenting with hematuria and low-grade proteinuria.

Figure 4. Electron Micrograph × 3000. Focal “hump-like” lesion (↑) and organizing sub-endothelial lesion (↑) from a patient presenting with hematuria and low-grade proteinuria.