[Glomerular nephropathies in hepatic cirrhosis (author's transl)]

Glomerular lesions were studied in 41 patients with hepatic cirrhosis (32 cases) or steatosis (9 cases) by optical microscopy (38 cases) and immunofluorescence (22 cases) examinations of biopsy samples. The most frequently observed lesion on optical microscopy was a glomerulosclerosis (16 cases), arteriolar lesions being present in 15 cases, two-thirds of which had associated glomerular lesions. Immunofluorescence revealed the presence of immunoglobulin deposits in 17 cases, these possessing two main characteristics: the prevalence of IgA (14 cases), alone or in association with other immunoglobulins; and the predilection for the mesangium alone, or in association with parietal deposits. The glomerular nephropathy in the cirrhotic patients was completely latent in 3 out of 4 cases, renal signs, when they existed, being of mild intensity. Renal lesion can occur in the absence of severe hepatopathy, particularly in the presence of steatosis. IgA deposits in the mesangium, a fundamental feature of hepatic glomerulopathy, can be related to the presence of IgA deposits in the liver sinusoids, suggesting the development of IgA deposits in several organs during these affections. Their pathogenesis is still obscure but two hypotheses have been suggested: an immune disease with deposits of circulating immune complexes in the kidney; a non-immune disease, IgA deposits being a secondary and not a primary feature.