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<p>A 67-year-old man with a history of hypertension and dyslipidemia presented with edema and heavy proteinuria. Light microscopic analysis of kidney biopsy revealed a diffuse segmental membranous feature. Immunofluorescence stain was segmentally positive for IgA, galactose-deficient IgA1, both κ and λ light chains, and C3 along the glomerular capillary walls, but negative for IgG, IgM, or C1q. Electron microscopy showed subepithelial and intramembranous electron-dense deposits (EDD) in the segmental glomerular capillary walls, along with foot process effacement in the corresponding areas. No EDD was observed in the mesangial or para-mesangial areas. The patient’s histopathology revealed membranous nephropathy with a solitary IgA deposition. No clinical findings suggested a secondary cause of membranous nephropathy. Combination therapy with corticosteroids and cyclosporine resulted in proteinuria remission. To our knowledge, this is the first reported case of membranous nephropathy with a segmental pattern associated with solitary IgA and galactose-deficient IgA1 deposition. Further case reports and studies are required to elucidate the pathogenesis of membranous nephropathy, which shows these unique histopathological features.</p>

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Membranous nephropathy as a segmental pattern with solitary immunoglobulin A deposition: a case report

  • 期刊论文

  • 发表日期：

    2025年8月27日

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  • Shinya Yokote,
  • Saeko Hatanaka,
  • Akihiro Shimizu,
  • Masahiro Okabe,
  • Kotaro Haruhara,
  • Takaya Sasaki,
  • Hiroyuki Ueda,
  • Kensuke Joh,
  • Nobuo Tsuboi,
  • Takashi Yokoo

摘要

A 67-year-old man with a history of hypertension and dyslipidemia presented with edema and heavy proteinuria. Light microscopic analysis of kidney biopsy revealed a diffuse segmental membranous feature. Immunofluorescence stain was segmentally positive for IgA, galactose-deficient IgA1, both κ and λ light chains, and C3 along the glomerular capillary walls, but negative for IgG, IgM, or C1q. Electron microscopy showed subepithelial and intramembranous electron-dense deposits (EDD) in the segmental glomerular capillary walls, along with foot process effacement in the corresponding areas. No EDD was observed in the mesangial or para-mesangial areas. The patient’s histopathology revealed membranous nephropathy with a solitary IgA deposition. No clinical findings suggested a secondary cause of membranous nephropathy. Combination therapy with corticosteroids and cyclosporine resulted in proteinuria remission. To our knowledge, this is the first reported case of membranous nephropathy with a segmental pattern associated with solitary IgA and galactose-deficient IgA1 deposition. Further case reports and studies are required to elucidate the pathogenesis of membranous nephropathy, which shows these unique histopathological features.