“Journey to the West”: Fact and Fiction. On the Chronicity-based Grading of IgA Nephropathy Model and Thick GCBM as Marker for a Syndrome

The pathological diagnosis of IgA nephropathy is straightforward and based on the distinctive mesangial deposition of dominant IgA-containing immune complexes, even though the pathogenesis is poorly understood and appears to be heterogeneous. The importance of clinical and morphological prognostic factors cannot be overemphasized. The chronicity-based histological grading of IgA nephropathy is stressed for its predictive impact and close correlation with the protracted course and disease progression. Extrapolation of the chronicity-base grading of IgA nephropathy to all other chronic nephritis is inferred, linking a fictional approach to the facts. The second topic describes the ongoing characterization of the isolated thick glomerular capillary basement membrane (TGCBM), which has accumulated sufficient attributes to link such a renal lesion to the metabolic syndrome. While the full significance of TGCBM remains to be investigated, as a marker of the metabolic syndrome, its recognition and diagnosis may have a preventive impact on the complications arising from the worldwide epidemic of diabetes and obesity.