Garland-pattern postinfectious glomerulonephritis with IgA-dominant deposition

Area of Science:

• Nephrology
• Pathology
• Immunology

Background:

• Acute postinfectious glomerulonephritis (APIGN) is a kidney disease often following infection.
• The garland pattern is a histological subtype of APIGN associated with a severe clinical course.
• Global reduction in APIGN morbidity has led to fewer recent reports, particularly in developed nations.

Purpose of the Study:

• To report a case of adolescent garland-pattern APIGN with IgA-dominant deposits.
• To review and compare 13 previously reported Japanese cases with the current case.
• To highlight the clinical and histological features, emphasizing IgA deposition's impact.

Main Methods:

• Case report of an adolescent patient with severe nephrotic syndrome, hematuria, and proteinuria.
• Literature review of 13 previously reported cases of garland-pattern APIGN in Japan.
• Comparative analysis of clinical and histological findings, focusing on IgA deposition.

Main Results:

• The presented case exhibited IgA-dominant deposits, severe nephrotic syndrome, and persistent hematuria/proteinuria.
• Review confirmed IgA deposition in at least three prior Japanese cases.
• Patients with IgA deposition showed a trend towards greater urinary protein excretion.

Conclusions:

• Garland-pattern APIGN, particularly with IgA deposition, can present with severe clinical manifestations.
• Increased clinical awareness is crucial for appropriate diagnosis and management of these patients.
• Further investigation into the role of IgA in garland-pattern APIGN is warranted.