IgA nephropathy

Basics

• also called Berger's disease or mesangioproliferative glomerulonephritis
• commonest cause of glomerulonephritis worldwide
• thought to be caused by mesangial deposition of IgA immune complexes
• there is considerable pathological overlap with Henoch-Schonlein purpura (HSP)
• histology: mesangial hypercellularity, positive immunofluorescence for IgA & C3

Presentations

• young male, recurrent episodes of macroscopic haematuria
• typically associated with mucosal infections e.g., URTI
• nephrotic range proteinuria is rare
• renal failure

Differentiating between IgA nephropathy and post-streptococcal glomerulonephritis

• post-streptococcal glomerulonephritis is associated with low complement levels
• main symptom in post-streptococcal glomerulonephritis is proteinuria (although haematuria can occur)
• there is typically an interval between URTI and the onset of renal problems in post-streptococcal glomerulonephritis

Associated conditions

• alcoholic cirrhosis
• coeliac disease/dermatitis herpetiformis
• Henoch-Schonlein purpura

Management

• steroids/immunosuppressants not be shown to be useful

Prognosis

• 25% of patients develop ESRF
• markers of good prognosis: frank haematuria
• markers of poor prognosis: male gender, proteinuria (especially > 2 g/day), hypertension, smoking, hyperlipidaemia, ACE genotype DD

© Image used on license from PathoPic

© Image used on license from PathoPic