Clinicopathological Profile of IgA Nephropathy: A Study of Tertiary Care Centre in Northern India

Abstract

Introduction: Immunoglobulin A Nephropathy (IgAN) is the most common Glomerulonephritis (GN) in the world which mainly occurs in the males of 30-40 years of age, following infections like tonsillitis, pharyngitis, pneumonia and Urinary Tract Infection (UTI). It presents with proteinuria, haematuria, hypertension, nephrotic syndrome, nephritic syndrome, acute renal failure and chronic renal failure. Immunofluorescence (IF) positivity is a must for its diagnosis. It is also common in India but there are only few studies done so far, due to non-availability of IF technique. Aim: To study the histopathological spectrum of IgAN and compared each with its clinical presentation. Materials and Methods: This was a descriptive study, conducted on all renal biopsies diagnosed as primary IgAN over a period of six years and six months (retrospective period was from 1st October 2007 to 30th September 2012 and prospective period was from 1st October 2012 to 31st March 2014) in the Department of Pathology, Christian Medical College and Hospital, Ludhiana. Renal biopsies’ sections of 3-4 µm thickness were made, stained with Hematoxylin and Eosin stain (H&E), Periodic Acid-Schiff (PAS), Masson’s Trichrome and Silver Methanamine and studied under light microscope. The renal biopsies were evaluated under the fluorescent microscope to study the positivity for the IgA, IgM, IgG, and C3. The histopathological classification was done according to the Haas System. These findings were compared with the clinical presentations. Results: Out of the 305 renal biopsies received, there were 60 (19.6%) cases diagnosed to have primary IgAN. The youngest patient aged two years and oldest patient aged 85 years. The mean age of presentation was 37.6 years. Majority, 16 (26.6%) of the patients were in the age group of 21-30 years. In all subclasses, there was a male preponderance with average male:female ratio of 3:1. Subclass V formed the largest group with 25 (41.67%) patients, which concludes that maximum patients came to hospital in a late stage. Conclusion: IgAN is a common entity seen in Northern part of India. But since most of the patients are coming in the late stage, makes it a missed diagnosis in earlier stages. Uncommon direct IF technique in India adds to this problem. Hence, appropriate steps like renal biopsies and its IF should be taken in patients with persistent haematuria and proteinuria for early diagnosis and management of the most common cause of GN of the world.

Keywords

• haas classification
• immunofluorescence
• renal biopsy