Nehprotic syndrome with glomerular mesangial IgM deposits
Cohen, A.H.; Border, W.A.; Glassock, R.J.
Laboratory Investigation; a Journal of Technical Methods and Pathology 38(5): 610-619
1978
ISSN/ISBN: 0023-6837 PMID: 347169 Document Number: 137894
Correlative light, electron and immunofluorescence microscopic studies of renal biopsies from patients presenting with the nephrotic syndrome or asymptomatic proteinuria identified a group of 12 whose glomeruli were characterized by morphologic evidence of mild mesangial alterations and the generalized and diffuse mesangial deposition primarily of Ig. No biopsy displayed segmental glomerulosclerosis and/or hyalinosis. Mesangial deposits were detected in 7 biopsies with Masson's trichrome stain in light microscopic preparations. EM revealed typical electron-dense deposits in 2 biopsies and ill defined mesangial densities in 5. In 3 biopsies, deposits were not detected at all by ultrastructural examination. Nine patients had nephrotic range proteinuria, 2 had asymptomatic proteinuria and 1 was evaluated because of renal failure. Hypertension was present in 3 patients. None had evidence of a systemic disease process or low serum complement; 5 of 7 tested had circulating immune complexes. In a limited number (five) of nephrotic patients, there was no uniform response to steroid therapy; in contrast, of 4 nontreated nephrotic patients, a partial remission was noted in one. This disorder may be a distinctive entity, which because of the constant immunofluorescence findings should be termed IgM mesangial nephropathy. Although it bears some similarity to minimal change disease, focal and segmental glomerulosclerosis and mesangial proliferative glomerulonephritis, the immunologic and structural features frequently permit a precise differentiation from these other glomerulopathies.