ATLAS OF RENAL PATHOLOGY

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IgA Nephropathy

Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman
With Assistance From the National Kidney Foundation's cyberNephrologyTM Team: Kim Solez, MD, Director; Joseph DeAlmeida, Computer Engineer; and Brenda Kalynchuk, Administrative Assistant

 
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Fig 1A. IgA nephropathy with minimal increase in mesangial matrix and cells (normal is less than or equal to 3 cells/mesangial area). The diagnosis must rely on additional immunofluorescence and electron microscopic studies ([A] periodic acid-Schiff, original magnification x200; [B] Jones' silver stain, original magnification x400).
 
 
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Fig 1B. IgA nephropathy with minimal increase in mesangial matrix and cells (normal is less than or equal to 3 cells/mesangial area). The diagnosis must rely on additional immunofluorescence and electron microscopic studies ([A] periodic acid-Schiff, original magnification x200; [B] Jones' silver stain, original magnification x400).
 
 
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Fig 2.Moderate diffuse mesangial expansion with increased matrix and cellularity in IgA nephropathy (Jones' silver stain, original magnification x100).
 
 
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Fig 3A. IgA nephropathy with moderate mesangial expansion with increased matrix and cells ([A] periodic acid-Schiff; [B] Jones' silver stain; original magnification for each x200).
 
 
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Fig 3B. IgA nephropathy with moderate mesangial expansion with increased matrix and cells ([A] periodic acid-Schiff; [B] Jones' silver stain; original magnification for each x200).
 
 
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Fig 4. Increased mesangial cellularity and matrix in IgA nephropathy (Jones' silver stain, original magnification x400).
 
 
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Fig 5A. IgA nephropathy may have superimposed segmental sclerosis in addition to variable mesangial increase. (A) A small peripheral sclerotic lesion with adhesion is present; (B) more advanced segmental sclerosis is shown ([A] Jones' silver stain; [B] periodic acid-Schiff; original magnification for each x200).
 
 
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Fig 5B. IgA nephropathy may have superimposed segmental sclerosis in addition to variable mesangial increase. (A) A small peripheral sclerotic lesion with adhesion is present; (B) more advanced segmental sclerosis is shown ([A] Jones' silver stain; [B] periodic acid-Schiff; original magnification for each x200).
 
 
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Fig 6. The diagnosis of IgA nephropathy rests on the finding of dominant or codominant IgA mesangial deposits, as shown here. Staining may also be present for IgG and IgM, but not in greater intensity than for IgA. C3 is also often present in the mesangial areas, usually equal to or less than IgA staining (anti-IgA immunofluorescence, original magnification x200).
 
 
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Fig 7.Henoch-Schönlein purpura (HSP) also has mesangial IgA deposits, and thus it appears morphologically like IgA nephropathy. Clinicopathological correlation is required to distinguish HSP from IgA nephropathy, but crescents, shown here, are more frequent in biopsied HSP than in IgA nephropathy (Jones's silver stain, original magnification x100).
 
 
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Fig 8.Mesangial electron dense deposits and increased mesangial matrix and cellularity in IgA nephropathy (transmission electron microscopy, original magnification x4,500).
 
 
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Fig 9. Mesangial electron dense deposits and increased mesangial matrix and cellularity in IgA nephropathy (transmission electron microscopy, original magnification x8,500).
 
 
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Fig 10. Marked increase in mesangial cellularity and matrix with massive mesangial dense deposits, with some extension of deposits to paramesangial areas. (Left) There is also interposition of cells in the glomerular basement membrane with new basement membrane formation on the endothelial aspect of the interposed cells (transmission electron microscopy, original magnification x4,800).
 

From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Address author queries to Agnes Fogo, MD, Department of Pathology, Vanderbilt University Medical Center, MCN C-3310, Nashville, TN 37232. E-mail:Agnes.Fogo@vanderbilt.edu
Am J Kidney Dis 31(4):E1, 1998 (available www.ajkd.org)
 Copyright © 1998 by the National Kidney Foundation, Inc.

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