First Description of IgA Glomerulonephritis (Berger's Disease)

Mirna Aleckovic-Halilovic and Mirha Pjanic

University Clinical Center Tuzla, Bosnia and Herzegovina,
Clinic for Internal Diseases,
Department for Nephrology, Dialysis and Renal Transplantation

Jean Berger was the renal pathologist who first characterized IgA nephropathy alongside Nicole Hinglais in 1968, and then in 1969 (1, 2), although P. Galle and Berger had described "intercapillary fibrinoid deposits" earlier, in 1962 (3). This distinct clinicopathological entity with predominant mesangial IgA deposits was soon realized to be the most prevalent primary chronic glomerular disease and an important cause of kidney failure worldwide. Until this breakthrough (1), laboratories using immunofluorescence mostly used only anti-IgG reagents, as IgG was thought to be the predominant immunoglobulin class involved in the immunopathogenesis of nephritis (4).

Ever since the publication of this seminal paper, the presence of IgA nephropathy is established only by kidney biopsy. Furthermore, the immunofluorescence findings are the pathologic hallmark of this disease. The light microscopic features of IgA nephropathy may vary greatly among patients and within individual biopsy samples.

Enormous efforts were put into research to identify the etiology and pathogenesis of IgA nephropathy. While they are still poorly understood, recent studies shed some light on the pathogenesis (see the narrative: “IgA hinge glycosylation in IgA nephropathy and IgA vasculitis”). Some studies have shown the efficacy of steroids and inhibition of the renin-angiotensin system, but there is no single therapeutic strategy shown to be effective against this disease.

The current state of knowledge regarding pathogenesis is that an initiating event is likely and that the main feature defining this glomerulonephritis is dominant or codominant mesangial deposits of IgA. Hence, Berger and his associates were the first to describe IgA nephropathy, and their work remains the backbone of diagnostics and today’s understanding of it.

While we are striving, in all areas of medicine, to move away from eponyms in naming diseases in pursuit of a better understanding of the underlying mechanisms, we acknowledge that, for many, IgA nephropathy will remain Berger's disease.

References

  1. Berger J, Hinglais N. Les dépôts intercapillaires d’IgA-IgG. J Urol Nephrol 1968; 74: 694–695.
  2. Berger J. IgA glomerular deposits in renal disease. Transplant Proc 1969; 1: 939–944.
  3. GALLE P, BERGER J: Depots fibrinoides intercapillaires. J Urol Nephrol (Paris) 68:123—127, 1962.
  4. Jean Berger (1930–2011) Feehally, John et al. Kidney International, Volume 80, Issue 5, 437 – 438.

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