GLOMERULONEPHRITIS-IgA NEPHROPATHY

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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)

  1. Wakai et al (2006) A scoring system to predict renal outcome in IgA nephropathy: from a nationwide prospective study. NDT
  2. Wakai et al (2006) A scoring system to predict renal outcome in IgA nephropathy: from a nationwide prospective study. NDT
  3. Berthoux et al (2011) Predicting the risk for dialysis or death in IgA nephropathy. JASN
  4. Berthoux et al (2011) Predicting the risk for dialysis or death in IgA nephropathy. JASN


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