GLOMERULONEPHRITIS-IgA NEPHROPATHY
SUMMARY
1. Most common cause of primary glomerulonephritis: peaks at 2nd/3rd decades of life, 2:1 male to female predominance.
2. Presentation: macroscopic haematuria (40-50%), microscopic haematuria (30-40%), nephrotic syndrome/rapidly progressive GN (10%), malignant HTN, AKI.
3. assoc. with liver cirrhosis, coeliac disease, HIV, minimal change disease, membranous nephropathy, granulomatosis with polyangitis (GPA).
4. Biopsy indications: proteinuria > 1g/day, AKI, new HTN or rapidly increasing BP.
5. Biopsy shows deposits of IgA and complement in the mesangium and in the glomerular capillaries on immunofluorescence staining.
6. Good prognostic factors: SCr ≤111 μmol/L[1], normal BP[2]; proteinuria was the most important predictor of renal outcome[3]
, proteinuria <1g/day offered better prognosis[4].
7. Use ACEis or ARBs for proteinuria (> 0.5 g/d) and progressive disease; use corticosteroid therapy when there is persistent proteinuria (> 1 g/d) despite 6 months on an ACEI/ARB.
8. The STOP IgA Trial showed that additional immunosuppressive therapy did not provide kidney-related benefits in patients with high-risk IgA nephropathy.
Reference(s)
- ↑ Wakai et al (2006) A scoring system to predict renal outcome in IgA nephropathy: from a nationwide prospective study. NDT
- ↑ Wakai et al (2006) A scoring system to predict renal outcome in IgA nephropathy: from a nationwide prospective study. NDT
- ↑ Berthoux et al (2011) Predicting the risk for dialysis or death in IgA nephropathy. JASN
- ↑ Berthoux et al (2011) Predicting the risk for dialysis or death in IgA nephropathy. JASN
Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
