Abstract
Occasional case reports have been issued on children with double glomerulopathy, involving either the coexistence of two different glomerulopathies or superimposition of a second glomerulopathy onto a first. A retrospective clinicopathological review of 294 children who had received renal biopsies resulted in 9 (3.1%) being confirmed to have double glomerulopathy. Superimposed glomerulopathy was diagnosed by a second renal biopsy in two cases, and coexistence of two glomerulopathies was confirmed by single biopsy in seven. Original glomerulopathies were those with a chronic course, such as Alport syndrome, IgA nephropathy, relapsing minimal-change nephrotic syndrome, Frasier syndrome, and thin basement membrane nephropathy. The superimposing glomerulopathies were common types in children, such as postinfectious glomerulonephritis, IgA nephropathy, and Henoch-Schönlein nephritis. Thus, the pattern of double glomerulopathy was considered to be due to the chance occurrence of two different glomerulopathies without a common pathogenesis. Acute nephritic symptoms of superimposed glomerulopathies resolved almost completely during follow-up in most cases. Double glomerulopathies are not rare in children and may occur by chance alone in most cases. The possibility of superimposed glomerulopathy should be suspected if the clinical course of a glomerulopathy changes atypically. However, the long-term influence of a superimposed glomerulopathy on renal functional deterioration remains unclear.
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Monga G, Mazzucco G, Barbiano di Belgiojoso G, Confalonieri R, Sacchi G, Bertani T (1990) Pattern of double glomerulopathies. A clinicopathologic study in nine nondiabetic patients. Nephron 56:73–80
Bertani T, Mecca G, Sacchi G, Remuzzi G (1986) Superimposed nephritis: a separate entity among glomerular diseases? Am J Kidney Dis 7:205–212
Horita Y, Tadokoro M, Taura K, Suyama N, Taguchi T, Miyazaki M, Kohno S (2004) Histologically confirmed superimposition of post-streptococcal acute glomerulonephritis during IgA nephropathy. Clin Exp Nephrol 8:351–355
Al-Ruqeishi N, Venugopalan P, El Nour I, Date A (2003) IgA nephropathy presenting clinical features of poststreptococcal glomerulonephritis. Pediatr Nephrol 18:956–958
Masutani K, Mizumasa T, Iwanaga T, Shinozaki M, Yanagida T, Kashiwagi M, Fukuda K, Kanai H, Katafuchi R, Hirakata H (2002) Superimposition of post-streptococcal acute glomerulonephritis on the course of IgA nephropathy: predominance of Th1 type immune response. Clin Nephrol 58:224–230
Mazzarolo-Cruz HM, Penna Dde O, Saldanha LB, Kanashiro EH, Cruz J, Malheiro PS, Marcondes M (1992) IgA nephropathy: acute renal failure, acute tubular necrosis, and features of postinfectious acute glomerulonephritis. Ren Fail 14:533–539
Hiki Y, Tamura K, Shigematsu H, Kobayashi Y (1991) Superimposition of poststreptococcal acute glomerulonephritis on the course of IgA nephropathy. Nephron 57:358–364
Okada K, Sone K, Minaguchi J, Kawashima S, Kagami S, Morimoto Y, Kuroda Y (1994) IgA nephropathy demonstrating clinico-serologic features of acute post-streptococcal glomerulonephritis. Clin Nephrol 41:117–118
Okada K, Saitoh S, Sakaguchi Z, Zhang RJ, Kuhara T, Yasutomo K, Kuroda Y (1996) IgA nephropathy presenting clinicopathological features of acute post-streptococcal glomerulonephritis. Eur J Pediatr 155:327–330
Kobayashi Y, Fujii K, Hiki Y, Chen XM (1985) Coexistence of IgA nephropathy and membranous nephropathy. Acta Pathol Jpn 35:1293–1299
Lai KN, Lai FM, Lo ST, Lam CW (1987) IgA nephropathy and membranous nephropathy associated with hepatitis B surface antigenemia. Hum Pathol 18:411–414
Jennette JC, Newman WJ, Diaz-Buxo JA (1987) Overlapping IgA and membranous nephropathy. Am J Clin Pathol 88:74–78
Doi T, Kanatsu K, Nagai H, Kohrogi N, Hamashima Y (1983) An overlapping syndrome of IgA nephropathy and membranous nephropathy? Nephron 35:24–30
Haas M, Jafri J, Bartosh SM, Karp SL, Adler SG, Meehan SM (2000) ANCA-associated crescentic glomerulonephritis with mesangial IgA deposits. Am J Kidney Dis 36:709–718
Ara J, Bonet J, Rodriguez R, Mirapeix E, Agraz I, Romero R (2005) IgA nephropathy with crescentic glomerulonephritis and ANCA positive. Nefrologia 25:712–717
Klassen J, Elwood C, Grossberg AL, Milgrom F, Montes M, Sepulveda M, Andres GA (1974) Evolution of membranous nephropathy into anti-glomerular-basement-membrane glomerulonephritis. N Engl J Med 290:1340–1344
Vozmediano C, Sanchez de la Nieta MD, Gonzalez L, Alvarez T, de la Torre M, Blanco J, Nieto J, Rivera F (2005) Membranous nephropathy and crescentic glomerulonephritis. Nefrologia 25:328–331
Hoshino J, Hara S, Ubara Y, Takaya H, Suwabe T, Sawa N, Tagami T, Katori H, Takemoto F, Hara S, Takaichi K (2005) Distribution of IgG subclasses in a biopsy specimen showing membranous nephropathy with anti-glomerular basement membrane glomerulonephritis: an uncharacteristically good outcome with corticosteroid therapy. Am J Kidney Dis 45:e67–e72
Sano T, Kamata K, Shigematsu H, Kobayashi Y (2000) A case of anti-glomerular basement membrane glomerulonephritis superimposed on membranous nephropathy. Nephrol Dial Transplant 15:1238–1241
Nishijima R, Araki A, Ando M, Nemoto T, Ohashi K, Kobayashi Y, Chiba Y, Horiuchi T, Morio K, Sawabe M, Hosoi T (2005) Diabetes mellitus complicated with rapidly progressive glomerulonephritis in an elderly patient. Int Med 44:1078–1083
Thitiarchakul S, Lal SM, Luger A, Ross G (1995) Goodpasture’s syndrome superimposed on membranous nephropathy. A case report. Int J Artif Organs 18:763–765
James SH, Lien YH, Ruffenach SJ, Wilcox GE (1995) Acute renal failure in membranous glomerulonephropathy: a result of superimposed crescentic glomerulonephritis. J Am Soc Nephrol 6:1541–1546
Moorthy AV, Zimmerman SW, Burkholder PM, Harrington AR (1976) Association of crescentic glomerulonephritis with membranous glomerulonephropathy: a report of three cases. Clin Nephrol 6:319–325
Abreo K, Abreo F, Mitchell B, Schloemer G (1986) Idiopathic crescentic membranous glomerulonephritis. Am J Kidney Dis 8:257–261
Koethe JD, Gerig JS, Glickman JL, Sturgill BC, Bolton WK (1986) Progression of membranous nephropathy to acute crescentic rapidly progressive glomerubonephritis and response to pulse methylprednisolone. Am J Nephrol 6:224–228
Gaber LW, Wall BM, Cooke CR (1993) Coexistence of anti-neutrophil cytoplasmic antibody-associated glomerulonephritis and membranous glomerulopathy. Am J Clin Pathol 99:211–215
Wu MJ, Osanloo EO, Molnar ZV, Daugirdas JT, Gandhi VC, Ing TS (1983) Poststreptococcal crescentic glomerulonephritis in a patient with preexisting membranous glomerulonephropathy. Nephron 35:62–65
Amenta PS, Swartz C, Katz SM (1989) Concurrent focal segmental glomerulosclerosis and membranous nephropathy. Clin Nephrol 32:173–177
Warwick GL, McLay A, Boulton-Jones JM (1991) Membranous nephropathy developing in a patient with previously diagnosed focal glomerulosclerosis. Am J Kidney Dis 18:520–522
Bertani T, Appel GB, D’Agati V, Nash MA, Pirani CL (1983) Focal segmental membranous glomerulonephropathy associated with other glomerular diseases. Am J Kidney Dis 2:439–448
Tanaka H, Waga S, Nakahata T, Kondo N, Onodera N, Monma N (2000) Acute glomerulonephritis superimposed on focal segmental glomerulosclerosis: a case report. Tohoku J Exp Med 191:177–181
Savige J, Rana K, Tonna S, Buzza M, Dagher H, Wang YY (2003) Thin basement membrane nephropathy. Kidney Int 64:1169–1178
Cosio FG, Falkenhain ME, Sedmak DD (1994) Association of thin glomerular basement membrane with other glomerulopathies. Kidney Int 46:471–474
Sue YM, Huang JJ, Hsieh RY, Chen FF (2004) Clinical features of thin basement membrane disease and associated glomerulopathies. Nephrology (Carlton) 9:14–18
Norby SM, Cosio FG (2005) Thin basement membrane nephropathy associated with other glomerular diseases. Semin Nephrol 25:176–179
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Cheong, H.I., Cho, H.Y., Moon, K.C. et al. Pattern of double glomerulopathy in children. Pediatr Nephrol 22, 521–527 (2007). https://doi.org/10.1007/s00467-006-0342-9
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DOI: https://doi.org/10.1007/s00467-006-0342-9