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Hypocomplementemia C3, acute kidney injury, low serum albumin, diffuse foot process effacement, and the Activity Index score independently differentiate IgA-dominant infection-related glomerulonephritis from IgA nephropathy, with the former demonstrating better short-term renal recovery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 24, 2026Open Access

A comparative study on the clinicopathological features and short-term prognosis of IgA-dominant infection-related glomerulonephritis and IgA nephropathy

JZJunfeng ZhongPeking University DYDheji YangzongThe People's Hospital of Guangxi Zhuang Autonomous Region YWYina WangSir Run Run Shaw Hospital

Key Points

This study aims to identify differentiating factors between IgA-dominant infection-related glomerulonephritis and IgA nephropathy based on their clinicopathological features and prognosis.
Retrospective analysis of 30 IgA-IRGN and 120 IgAN patients.
Utilized logistic regression analyses to evaluate associations between clinical features.
Monitored short-term prognosis based on estimated glomerular filtration rate and proteinuria remission at 6-month follow-up.
IgA-IRGN patients had higher mean arterial pressure and incidences of acute kidney injury (AKI) compared to IgAN patients.
Independent indicators for differentiation included hypocomplementemia C3 and low serum albumin.
IgA-IRGN patients demonstrated better short-term renal function recovery and higher proteinuria remission rates (P < 0.05).

Abstract

IgA-dominant infection-related glomerulonephritis (IgA-IRGN) and primary IgA nephropathy (IgAN) share similar clinicopathological features, making differentiation challenging despite distinct therapeutic strategies. This study compares the clinicopathological characteristics and short-term prognoses of the two conditions to identify diagnostic differentiators. This retrospective study included patients diagnosed with IgA-IRGN ( n = 30) and IgAN ( n = 120). We comparatively analyzed their clinical and pathological features, as well as the short-term prognostic differences. Univariate and multivariable logistic regression analyses were conducted to evaluate independent associations. Different pathological scoring systems were utilized to assess their diagnostic value. Short-term prognosis was evaluated at a 6-month follow-up, based on changes in the estimated glomerular filtration rate (eGFR) and the remission rate of proteinuria. Compared to IgAN, IgA-IRGN patients had higher mean arterial pressure, incidences of edema, acute kidney injury (AKI), and hypertension. Serum albumin, eGFR, and complement C3 were lower, while 24-hour proteinuria, neutrophil-to-albumin ratio (NAR), and neutrophil-to-C3 ratio (NC3r) were higher. Pathologically, IgA-IRGN showed diffuse endocapillary hypercellularity (100% vs. 2.5%) and universal subepithelial “hump-like” deposits (100% vs. 0.89%). Multivariable analysis revealed hypocomplementemia C3, AKI, and serum albumin could serve as non-invasive differentiating indicators. After incorporating pathological factors, hypocomplementemia C3, the Lupus Nephritis Activity Index (AI) score, and diffuse foot process effacement emerged as independent differentiating factors. IgA-IRGN patients demonstrated better short-term renal function recovery and higher proteinuria remission rate ( P < 0.05). Significant clinicopathological differences exist between IgA-IRGN and IgAN. Hypocomplementemia C3, AKI, low serum albumin, diffuse foot process effacement, and the AI score were independent indicators for differentiation. IgA-IRGN patients experience better short-term renal recovery and proteinuria remission than IgAN patients.

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