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Art of Medicine: IgA Nephropathy

IgA Nephropathy
The above painting shows glomeruli with mesangial hypercellularity, endocapillary hypercellularity, and crescent formation.  These findings can be seen in IgA nephropathy, and other active glomerulonephritides.  These lesions shown in the painting above are represented in the Oxford Classification for IgA nephropathy.  The Oxford classification is a scoring system on kidney biopsies that  includes mesangial hypercellularity (M0 = <50%, M1 = >50%), endocapillary hypercellularity (E0 = none, E1 = present), segmental sclerosis (S0 = absent, S1 = present), tubular atrophy / interstitial fibrosis (T0 = <25%, T1 25-50%, T2 >50%), and crescents (C0 = absent, C1 = up to 25%, C2...

Twitter Poll (May 22, 2019)

IgA nephropathy, Twitter Poll, Arkana Laboratories, kidney pathology, renal disease
ANSWER: C By the Oxford Classification of IgA nephropathy, the findings present are classified as "M1 E1 S1 T1 C0" (where M=Mesangial hypercellularity; E=Endocapillary proliferation; S=Segmental sclerosis; T=Tubular atrophy & interstitial fibrosis; C=Cellular/fibrocellular crescents). REFERENCE: Trimarchi H, et al. Oxford Classification of IgA Nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int 2017; 91(5):1014-21.    

Crescentic IgA nephropathy

IgA, Crescentic IgA Nephropathy, chronic kidney disease, Arkana Laboratories
The patient is a 17-year-old white female who presents with 2.85 grams/24 hr proteinuria, microscopic hematuria, and a creatinine of 3.2 mg/dl. She was in her normal state of health and was incidentally found to have abnormal lab values and urinalysis at a routine sport's physical. She reports that she had noticed a little more fatigue the last few months, but had blamed this on being busy at her job after school. Figure 1 shows focal fibrinoid necrosis. Figure 2 shows moderate tubular atrophy and interstitial fibrosis. Figures 3 & 4 show a segmental cellular crescent. Figure 5 shows several...

IgA Nephropathy Oxford Scoring

The IgA nephropathy Oxford Classification was first published in 2009 by a working group of nephrologists and renal pathologists representing the Renal Pathology Society and International IgA Nephropathy Network. The lesions currently scored include mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, tubular atrophy/interstitial fibrosis, and cellular/fibrocellular crescent formation. Two of these lesions, crescent formation (A) and mesangial hypercellularity (B), are shown here.  For the purposes of the Oxford classification, mesangial hypercellularity is defined as >3 mesangial cell nuclei in a mesangial area not adjacent to the vascular pole (in sections cut to 3-micron thickness).