IgA Nephropathy Flashcards
what is IgA nephropathy?
also known as Berger’s disease
commonest cause of glomerulonephritis
how can IgA nephropathy present?
macroscopic haematuria following URTI
typically 1-2 days after
young males
rapid recovery between attacks
what conditions are associated with IgA nephropathy?
alcoholic cirrhosis
coeliac disease/dermatitis herpetiformis
henoch-schonlein purpura
what is the pathophysiology of IgA nephropathy?
IgA immune complexes deposition in mesangium
what are biopsy histology findings for IgA nephropathy?
IgA deposition in mesangium
mesangial hypercellularity
positive immunofluorescence for IgA and C3
what is the difference between IgA nephropathy and post-streptococcal glomerulonephritis?
post-streptococcal glomerulonephritis is associated w low complement levels
main symptom in post-streptococcal glomerulonephritis is proteinuria - though haematuria can occur
typically an interval (1-2 weeks) between URTI and onset of renal problems in post-streptococcal glomerulonephritis
what is the management of IgA nephropathy?
- if isolated haematuria, no/minimal proteinuria <500-1000mg/d + normal eGFR
- no treatment
follow-up to check UE - persistent proteinuria >500-1000mg/d, normal/slightly reduced eGFR
- initially start ACEi - active disease (falling eGFR) or failure to respond to ACEi
- immunosuppression w corticosteroids
what is the prognosis of IgA nephropathy?
25% patients develop ESRF after 20 years
can occasionally lead to nephritic syndrome
what are markers of good prognosis in IgA nephropathy?
frank haematuria
what are markers of poor prognosis in IgA nephropathy?
male
proteinuria esp >2g/d
HTN
hyperlipidaemia
smoking
ACE genotype DD
what is the treatment of IgA nephropathy?
steroids
if decreased renal function- cyclophosphamide
