Pathology of IgA nephropathy

Key Points IgA nephropathy is defined by the presence of IgA-dominant or co-dominant glomerular deposits Glomerular changes under light microscopy are diverse, ranging from minimal abnormality to crescentic glomerulonephritis, or an appearance resembling primary focal segmental glomerulosclerosis Mesangial hypercellularity, segmental glomerulosclerosis and tubular atrophy/interstitial fibrosis are of prognostic value and predict renal outcomes independent of clinical variables Evidence from retrospective clinicopathological studies indicates that endocapillary hypercellularity and cellular crescents are responsive to steroid and/or immunosuppressive therapy Prospective data from randomized control trials are required to determine how histopathology should be used to guide therapy