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Acute and active forms of IgAN are associated with endocapillary hypercellularity and vascular damage of various degrees, in severe cases with microangiopathy (MA) without or with thrombosis [thrombotic microangiopathy (TMA)]. Vascular damage activates complement and coagulation cascades. A defective complement regulation has recently been detected in active and progressive cases of IgAN. C4d deposits in renal biopsies have been found to be an early risk factor. These observations have raised interest in manifestation of MA and TMA in progressive cases of IgAN. MA\u2013TMA lesions have been found in various percentages (2\u201353%) of patients with IgAN according to patients\u2019 selection and pathology definition of TMA. The association with hypertension (HTN) was so strong that it led to the hypothesis that MA\/TMA in IgAN was a mere consequence of severe HTN. Old and new clinical and experimental data indicate that in IgAN the interaction of the glomerular capillary wall with immune reactants and complement uncontrolled activation leading to C4b deposits favours the development of MA\u2013TMA, which plays a role in progression and renal function decline. The central role of complement activation is relevant also for the new therapeutic interventions offered by the pharma.<\/jats:p>","DOI":"10.1093\/ndt\/gfz241","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T03:23:11Z","timestamp":1571973791000},"page":"581-586","source":"Crossref","is-referenced-by-count":47,"title":["Glomerular endothelial activation, C4d deposits and microangiopathy in immunoglobulin A nephropathy"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6921-4811","authenticated-orcid":false,"given":"Hern\u00e1n","family":"Trimarchi","sequence":"first","affiliation":[{"name":"Nephrology Service, Hospital Brit\u00e1nico de Buenos Aires, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosanna","family":"Coppo","sequence":"additional","affiliation":[{"name":"Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,11,22]]},"reference":[{"key":"2021033008570406300_gfz241-B1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.nephro.2018.02.004","article-title":"Recent advances in the physiopathology of IgA nephropathy","volume":"14","author":"Monteiro","year":"2018","journal-title":"Nephrol Ther"},{"key":"2021033008570406300_gfz241-B2","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1038\/ki.2009.168","article-title":"The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility","volume":"76","author":"Roberts","year":"2009","journal-title":"Kidney Int"},{"key":"2021033008570406300_gfz241-B3","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.kint.2017.02.003","article-title":"Oxford classification for IgA nephropathy 2016. 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