Immune complexes in acute adult-onset Henoch-Schonlein nephritis

Marc Hilhorst, Pieter van Paassen, Peter van Breda Vriesman, Jan Willem Cohen Tervaert*

*Corresponding author for this work

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Background. Adult-onset Henoch-Schonlein purpura nephritis (HSPN) and primary IgA (IgAN) nephropathy have been considered indistinguishable immunohistopathologically and are often considered as two extremes of one disease entity. We postulate that adult-onset Henoch-Schonlein can be distinguished histologically from primary IgAN and that both diseases differ in their immunopathological mechanisms. Methods. Twenty consecutive patients with adult-onset HSPN were studied. Serum was analysed for circulating IgA immune complexes; renal biopsies were analysed by light and electron microscopy (EM). As disease controls, 40 IgAN patients were studied. Results. Intracapillary leukocyte margination was seen in 15 of the 20 patients and cellular crescent formation in all renal biopsies of the HSPN patients. IgAN biopsies showed a few small crescents without intracapillary leukocytes. In 16 HSPN patients, EM was performed and in 10, no dense deposits were found. In all biopsies of IgAN patients, typical 'humps' were found. In 6 of 9 analysed HSPN patients, intermediate to large circulating immune complexes were found, whereas in 4 of 28 analysed patients with primary IgAN small circulating immune complexes were found. Conclusions. We consider adult-onset HSPN distinguishable in histology and ultrastructure from primary IgAN. We believe adult-onset Henoch-Schonlein to be a circulating immune complex disease.
Original languageEnglish
Pages (from-to)3960-3967
JournalNephrology Dialysis Transplantation
Issue number12
Publication statusPublished - Dec 2011


  • electron microscopy
  • glomerulonephritis
  • Henoch-Schonlein purpura
  • IgA nephropathy
  • immune complexes

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