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Immunoglobulin A nephropathy (IgAN) is characterized by mesangial cell proliferation and mesangial expansion with mesangial depositions of IgA. We have found that electron-dense deposits (EDD) are often observed in areas other than paramesangial areas in glomeruli. To compare electron microscopic findings with light microscopic findings and clinical data, we examined the biopsies from 178 patients with IgAN. Patients were divided into two groups: group A had only paramesangial deposits and group B had deposits not only in paramesangial areas but also in other areas. All patients examined in this study had EDD in glomerular paramesangial areas. Thirty-six patients were included in group B. Cellular crescent formation in glomeruli and urinary protein in group B were significantly higher than those in group A ( P < 0.01). Serum albumin and estimated glomerular filtration rate (eGFR) in group B were significantly lower than those in group A ( P < 0.05). Group B showed a significant positive correlation with histological severity, which is defined in the Japanese Clinical Guidelines on IgAN. In patients with broad distribution of EDD, urinary protein was significantly increased ( P < 0.05). Detailed observation of EDD distribution has an impact on evaluation of the disease activity of IgAN.

In a search for correlations between glomerular morphology and clinical manifestations in acute post-streptococcal glomerulonephritis, data for 40 biopsied patients were reviewed. A major correlation was observed between severe hypoalbuminemia and the absence of deposits on the paramesangial portion of the glomerular basement membrane. Subepithelial deposits were present on both the capillary loop and paramesangial segments of the basement membrane in 29 patients, whereas in 11 the deposits were present only on the capillary loop. Patients with paramesangial segments devoid of deposits had a mean (+/-1 SD) nadir serum albumin level of 1.90 (+/-0.40) g/dl, whereas the mean nadir level in those with deposits in both locations was 2.83 (+/-0.64) g/dl (P<0.001). Also significant was the difference in paramesangial deposit scores in patients with nadir serum albumin levels < or =2.5 g/dl versus those with levels >2.5 g/dl. The amount of subepithelial deposit on the capillary loop was not significantly different in the two groups, and no correlation was found between loop deposits and serum albumin levels. Except for greater edema and significantly less-frequent gross hematuria in those with absent paramesangial deposits, clinical and laboratory findings for the two groups did not differ.