ISSN: 2251-8363    eISSN: 2251-8819  
J Nephropathol. 2015;4(1):1-5.
doi:10.12860/jnp.2015.01
PMID: 25657978
PMCID: PMC4316579

Scopus id: 84925177769

Short-Review

Extracapillary proliferation in IgA nephropathy; recent findings and new ideas

Hamid Nasri 1, Muhammed Mubarak 2 *

1 Department of Nephrology, Division of Nephropathology, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
Corresponding author: Prof. Muhammed Mubarak, Histopathology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Email: drmubaraksiut@yahoo.com

Abstract

Context: IgA nephropathy (IgAN) is an autoimmune disorder and is the most common form of primary glomerulonephritis (GN) worldwide.

Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, PubMed (NLM), LISTA (EBSCO) and Web of Science have been searched.

Results: It is a slowly progressing disorder that leads to end-stage renal disease (ESRD) in up to 50% of the patients within 25 years of the onset of the disease. IgAN is defined by predominant IgA deposition in the mesangial area on immunofluorescence (IF) microscopy. Its histology varies from mild focal segmental proliferation of mesangial cells to severe diffuse global proliferation with extracapillary proliferation (crescent formation). The Oxford classification, designed in 2009, is a new classification for the evaluation of morphologic lesions of IgAN. This classification, containing four pathology variables, was found to have prognostic implications. The variables included are mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S) and the proportion of interstitial fibrosis and tubular atrophy (T). However, crescents were not included in the Oxford classification.

Conclusions: In this mini-review, we describe the recent publications about the significance of extracapillary proliferation in IgAN and we conclude that, there is much controversy about the role of extracapillary proliferation as a significant prognostic factor in IgAN. Hence, it is important to re-consider crescents in IgAN patients. Therefore, we suggest further investigations on this aspect of IgAN disease.

Implication for health policy/practice/research/medical education:

There is still controversy about the role of extracapillary proliferation as a significant prognostic factor in IgAN. It is important to conduct more studies on the value of crescents in IgAN patients on the pattern adopted for the development of the original classification before these lesions are included in the Oxford classification of IgAN.

Please cite this paper as: Nasri H, Mubarak M. Extracapillary proliferation in IgA nephropathy; recent findings and new ideas. J Nephropathol. 2015; 4(1): 1-5. DOI: 10.12860/jnp.2015.01

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First published online: 01 Jan 2015
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