A retrospective study of 1,006 patients with biopsy-confirmed IgA nephropathy (IgAN) found that glomerular basement membrane (GBM) thickening on electron microscopy was associated with a higher risk of progression to end-stage kidney disease (ESKD). GBM thickening was uncommon, occurring in 3% of patients, but those patients had significantly shorter ESKD-free survival than those with normal GBM thickness. The association persisted after adjustment for Oxford MEST-C findings and the International IgAN Prediction Tool, suggesting that GBM ultrastructure may provide prognostic information beyond established risk measures.
The findings underscore that closer attention to electron-microscopy findings may help refine risk assessment when reviewing kidney-biopsy results in IgAN. GBM thickening was also associated with mesangial hypercellularity, raising the possibility that these structural changes reflect broader glomerular injury. However, the study was retrospective and conducted at a single center, and only 29 patients had GBM thickening, limiting the strength and generalizability of the findings. Prospective studies in larger and more diverse populations are needed before GBM thickness can be incorporated routinely into IgAN prognostic assessment.
Reference: Zhengying F, Mingxin Y, Wenjie W, et al. Thickening of Glomerular Basement Membrane Is Associated with Long-Term Prognosis in Patients with IgA Nephropathy. Kidney360. 2026 Jun 1;7(6):1356-1364. doi: 10.34067/KID.0000000885.
