Associations of left renal vein entrapment with IgA nephropathy and Henoch-Schönlein purpura nephritis

Fengmei Wang; Huizi Zhu; Shougang Bao; Hengtao Qi; Liang Xu; Xiang Liu; Chunjuan Zhai; Xiaowei Yang; Rong Wang

doi:10.1080/0886022X.2022.2118065

Associations of left renal vein entrapment with IgA nephropathy and Henoch-Schönlein purpura nephritis

Ren Fail. 2022 Dec;44(1):1519-1527. doi: 10.1080/0886022X.2022.2118065.

Authors

Fengmei Wang¹, Huizi Zhu², Shougang Bao³, Hengtao Qi³, Liang Xu⁴, Xiang Liu⁴, Chunjuan Zhai⁵, Xiaowei Yang⁴, Rong Wang^{2

4}

Affiliations

¹ Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, P. R. China.
² Department of Nephrology, Shandong Provincial Hospital, Shandong University, Jinan, P. R. China.
³ Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, P. R. China.
⁴ Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, P. R. China.
⁵ Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, P. R. China.

Abstract

Objectives: The aims of the study were to identify whether left renal vein (LRV) entrapment was more prevalent in IgA nephropathy (IgAN) and Henoch-Schönlein purpura nephritis (HSPN) compared with other types of renal diseases, and the association of LRV entrapment with glomerular incidental IgA and galactose-deficient-IgA1 (Gd-IgA1) deposition.

Methods: A total of 797 patients with biopsy-proven kidney diseases have been screened for LRV entrapment by color Doppler ultrasound, and the prevalence of LRV entrapment in different types of renal diseases were then analyzed. Propensity score matching analysis was used to adjust for age, gender, and body mass index. Immunostaining of Gd-IgA1 with KM55 was performed in paraffin-embedded sections of renal biopsy specimens.

Results: LRV entrapment was diagnosed in 47 patients (6%) with several kinds of renal diseases in our cohort. A total of 32 (68%) LRV entrapments were combined with expanded IgAN (idiopathic IgAN and HSPN). The prevalence of LRV entrapment in expanded IgAN was significantly higher than that in non-expanded IgAN (17 vs. 2%, p < 0.001), even after adjustment for age, gender, and body mass index by propensity score matching analysis (13 vs. 2%, p < 0.001). Removing expanded IgAN and LN, glomerular incidental IgA deposition was observed to be significantly more common in patients with LRV entrapment compared with patients without it (43 vs. 9%, p < 0.001). Furthermore, in glomerular diseases with incidental IgA deposits, significantly much larger proportion of patients with LRV entrapment were positive for glomerular Gd-IgA1 in contrast to patients without LRV entrapment (5/5 vs. 5/17, p = 0.01).

Conclusions: LRV entrapment coexisted with several kinds of renal diseases, with a significantly higher prevalence in patients with idiopathic IgAN and HSPN. In patients of LN and IgAN-unrelated disease with LRV entrapment, glomerular IgA and Gd-IgA1 deposition was more common compared with patients without LRV entrapment.

Keywords: Henoch–Schönlein purpura nephritis; IgA nephropathy; Left renal vein entrapment; biopsy-proven renal diseases.

MeSH terms

Glomerulonephritis* / complications
Glomerulonephritis, IGA* / complications
Glomerulonephritis, IGA* / pathology
Humans
IgA Vasculitis* / complications
Immunoglobulin A
Nephritis*
Renal Veins / pathology

Substances

Immunoglobulin A

Grants and funding

This work was supported by grants of Taishan Scholars Program of Shandong Province [grant number ts201712090], Academic promotion programme of Shandong First Medical University [grant number 2019QL022], the National Natural Science Foundation of China [grant numbers 82060132, 81400704], Science and Technology Assistance Project of Science and Technology Department of Xinjiang Autonomous Region [grant number 2020E0276] and Nanjing municipal commission of health and family planning [grant numbers 7990000097, YYKK20240].