Cirrhotic glomerulonephritis: incidence, morphology, clinical features, and pathogenesis

Glomerulonephritis is a little known manifestation of liver cirrhosis. Since the introduction of sophisticated immunologic staining methods, glomerular morphologic abnormalities have been noted in more than 50% of patients with cirrhosis at both necropsy and biopsy. The distinctive pathologic findings consist of glomerular mesangial IgA deposits usually accompanied by complement deposition. Increased serum IgA levels are found in over 90% of cirrhotic patients with glomerular IgA deposition. Cirrhotic glomerulonephritis is usually a clinically silent disease, however, the diagnosis can be suspected by finding proteinuria or abnormalities of the urine sediment. The pathogenesis may relate to defective hepatic processing and/or portacaval shunting of circulating immune complexes.