Atika Masood, Munazza Azam, Alia Waheed.
Morphological Patterns of IgA Nephropathy with aid of iNOS.
Pak J Med Health Sci Jan ;12(2):530-4.

Background: The most common form of primary glomerulonephritis is primary or idiopathic IgA nephropathy. The mainstay of diagnosing IgA nephropathy remains immunofluorescence microscopy which shows predominantly IgA deposits and C3 scapillary walls. Induction of iNOS occurs as an initial rapid response to immune insult in glomerulonephritis (GN). Methods: One hundred and thirty two consecutive patients of nephrotic and nephritic syndrome, both children and adult, were included in the study. After baseline investigations and serum IgA level, 33 patients having clinical suspicion of IgA nephropathy and 1 patient of Henoch Schonlein purpura nephritis were admitted and renal biopsies were taken by well trained nephrologists after consent from the patients and/ or parents of the patient in care of a child . These cases were selected from Sheikh Zayed Hospital, Children Hospital, Services Hospital, Fatima Memorial Hospital and Jinnah Hospital Lahore . Results: Among these 34 renal biopsies, 23(67.65%) were males and 11 (32.35%) were females. The minimum age at biopsy was 2 years and maximum was 73 years, mean +-S.D of age was 28.18 +-19.62. Among the 34 patients microscopical hematuria was present in 17 (50%) and macroscopic haematuria in 10 (29.4%). Duration for haematuria was minimum 1 month and maximum 72 months with mean +-S.D of 10.0 +-15.63. Among the 34 patients 32 were detected to have proteinuria. Sixteen (47.1%) had < 2g/ 24hrs while 16(47.1%) had > 2g/ 24hrs proteinuria. Duration of proteinuria was minimum 1 month and maximum 24 months with mean +-S.D of 6.59 +-6.66 .The minimum serum creatinine was 0.60 mg/dl and maximum serum creatinine was 12.80 mg/dl with a mean +-S.D serum creatinine being 2.92 +-3.14 mg/dl. Serum IgA level was performed in all the 34 patients out of which 20 (58.82%) showed raised level while 14 (41.17%) cases showed normal IgA levels. Among 34 clinically suspected of IgA nephropathy, 17 cases turned out to be of IgA nephropathy after morphological and IF studies. Conclusion: Diagnosis of IgA nephropathy cannot be made clinically as it has not proven a reliable method so renal biopsy in addition to the H&E and histochemistry should be examined using immunofluorescence that is mandatory for the correct diagnosis of IgA nephropathy iNOS expression can differentiate between proliferative and non proliferative forms of IgA nephropathy at a very early stage, hence very helpful in making a correct diagnosis.

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