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| Year : 2012 | Volume
: 55
| Issue : 1 | Page : 127-128 |
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| Authors' reply |
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AV Vanikar
Department of Nephrology and Transplantation Medicine, Gujarat, India
Click here for correspondence address and email
| Date of Web Publication | 11-Apr-2012 |
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How to cite this article:
Vanikar A V. Authors' reply. Indian J Pathol Microbiol 2012;55:127-8 |
The age group of 25 biopsies excluded from this study was pediatric (1 to 12 years). We have not discussed the incidence of IgM nephropathy in children in this paper. We have submitted a separate paper on that issue which is being considered for publication in another journal. Thus, the number 2 928 indicates total biopsy load.
We would like to clarify that this was a retrospective analysis of total native renal biopsies performed. The patients who presented with SDNS/SRNS/nephrotic-nephritic syndrome and showed IgM nephropathy were considered for finding out the incidence of IgM nephropathy in our adult and adolescent population. So, we have avoided the issues of indications of biopsy since the paper was on IgM nephropathy.
We would like to address the authors of this letter that there is no study available at least to our knowledge on the incidence of IgM nephropathy in adults and adolescents. The references we came across were of studies of IgM nephropathy in toto and incidentally majority of the patients in these studies were found to be children.
Our paper is a humble attempt to define IgM nephropathy in adults and adolescents and to our knowledge, this is the first study of its kind.
We agree that biopsies for AUA are performed rarely and we too have limited experience of such cases, e.g., we have seen about 15 to 20 such biopsies in the span of last 20 years, with no renal pathology in them.
We agree that this was a mixed group with MCD-MePGN and minimal morphological changes.
This was a representative sample with minimal/no morphological change. Regarding the choice of stain, one can use H and E or PAS stain. I agree that PAS is still the best choice for evaluation of a biopsy.
We agree that the other immune reactants have been calculated for all 142 cases. In 117 adult biopsies, sole IgM deposits were seen in 105 (89.7%), IgM + C3 deposits were noted in 3 (2.6%), IgM + C3 + IgG were noted in 4 (3.4%), IgM + IgG were noted in 3 (2.6%), and IgM + IgA were noted in 2 (1.7%) biopsies. Thus, there will be minor change in percentage distribution of immune deposits; however, we would like to reiterate that these immune deposits had no role in prognostication.
We have observed that IgMN with FSGS has the worst prognosis as compared with other lesions, and in fact, we have observed even worst prognosis of these cases as compared with FSGS without IgM deposits. In abstract due to limitations of permissible words, we were not able to clarify in details on this point; however, we have described in the result section of the manuscript in details. We have tried to state that FSGS had no remission, which means no respite in proteinuria.
Correspondence Address:
A V Vanikar
Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
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