IgA Nephropathy

Question 1

epidemiology

Answer 1

most common primary glomerulonephritis in adults
usually male in second to third decade of life
more common in asain population

Question 2

pathophysiology of IgA nephropathy

Answer 2

cause is still not entirely understood
likely increased number of defective circulating antibodies are synthesised
they form immune complexes that deposit in the renal mesangium
compliment system activation leads to glomerulonephritis

Question 3

clinical features of IgA nephropathy

Answer 3

may be asymptomatic
may cause recurring episodes of gorss or microscopic haematuria, flank pain, low grade fever, nephritic syndrome
usually during or immidiately following a resp of GI infection

Question 4

whats the difference between IgA nephropathy and IgA vasculitis

Answer 4

vasculitis usually occurs in children <10 and affects multiple organ systems including palpable purpura, abdo pain, arthhralgia
IgA nephropathy is limited to the kidneys and typically affects adults

Question 5

urinalysis

Answer 5

signs of nephritic sediment, including persistant microhaematuria and possibly minor proteinuria
episoding flare ups of gross haematruia in 50% of patients
nephrotic sediment in rare cases

Question 6

lab tests

Answer 6

serum IgA levels raised in 50% of patients
compliment levels are generally normal

Question 7

renal biopsy

Answer 7

usually only indicated for severe or progressive disease
mesangial proliferation and IgA deposits
mesangial immune complex deposits

Question 8

how would you tell this apart from post strep glomerulonephritis

Answer 8

PSGN is associated with low compliment levels
PSGN usually occurs 10-20 days following an infection, usually tonsillitis

Question 9

treatment

Answer 9

pateints with isolated haematuria: monitor kidney function, symptoms resolve in 30%
patients with protienuria or hypertension: ACEI, ARBs
for severe disease: glucocorticoids plus cyclophosphamide/azathioprine