What Is IgA Nephrology?

IgA nephropathy is the most common type of primary glomerular disease, which refers to the deposition of IgA or IgA in the mesangial region, with or without other immunoglobulins deposited in the mesangial region. Primary glomerulopathy. The types of lesions include focal segmental lesions, intra-capillary proliferative lesions, mesangial proliferative lesions, crescentic lesions, and sclerotic lesions. Its clinical manifestations are recurrent macroscopic hematuria or microscopic hematuria, which may be accompanied by varying degrees of proteinuria, and some patients may develop severe hypertension or renal insufficiency.

Basic Information

Also known as: Berger disease
Visiting department: Nephrology

Common symptoms: Gross hematuria, microscopic hematuria
Contagious: no

Causes of IgA nephropathy

The etiology is unknown. Primary IgA nephropathy is caused by a disease of the kidney itself. Secondary IgA nephropathy is caused by diseases other than the kidney, such as purpuric nephritis, HIV infection, serum-negative spinal arthritis, tumors, leprosy, liver disease, familial IgA nephropathy, and the like.

Clinical manifestations of IgA nephropathy

Recurrent macroscopic hematuria occurs after 1 to 3 days of upper respiratory tract infection, which can be converted to microscopic hematuria after several hours to several days. It may be accompanied by abdominal pain, low back pain, muscle pain or low fever. Some patients found abnormal urine during physical examination. Asymptomatic proteinuria and / or microscopic hematuria, a few patients have persistent gross hematuria and varying degrees of proteinuria, which can be accompanied by edema and hypertension.

IgA nephropathy test

Immunological examination

50% of patients had elevated serum IgA levels. Specific circulating immune complexes containing IgA were detected in 37% to 75% of patients.

2. Urine test

Proteinuria quantification and typing are important for the diagnosis and prognosis of IgA nephropathy. Those with proteinuria <1g / 24h are usually mild and focal mesangial hyperplasia. Moderate to severe proteinuria is mostly diffuse mesangial hyperplasia, often accompanied by crescent and glomerulosclerosis. Hematuria: The morphology of urine RBC is polymorphic, suggesting that the source of hematuria is glomerular.

3. Renal function test

The increase of serum creatinine to 1.5mg / dl (132.6umol / L) is mostly the progression of the disease. When GFR <20ml / min, the pathological changes are above grade .

IgA nephropathy diagnosis

The diagnosis of IgA nephropathy must be based on renal biopsy pathology and must be supported by the results of immunofluorescence or immunohistochemistry. Its diagnostic characteristics are: diffuse mesangial hyperplasia or focal segmental proliferative glomerulonephritis commonly seen under light microscopy; immunofluorescence can show mesangial area IgA or IgA-based immune complex deposition, which is the diagnosis of IgA nephropathy Sign.

IgA nephropathy treatment

There is no special treatment for this disease. Different measures are adopted clinically according to the patient's different manifestations and course of disease. The purpose is to protect renal function and slow down the disease progression. The clinical classification of IgA nephropathy is as follows:

Solitary microscopic hematuria

No special treatment is needed and regular follow-up is required.

2. Recurrent gross hematuria

For lesion removal, such as tonsillectomy, triple therapy (triptoside, emodin, ACEI / ARB) can be used according to the amount of proteinuria.

3. abnormal urine test

Triple therapy (triptoside, emodin, ACEI / ARB).

4. Vasculitis type

(1) MMF treatment plan : Methylprednisolone intravenous infusion shock treatment for three days, followed by prednisone 0.6mg / (kg.d), reduced by 5mg / d to 10mg / d every 2 weeks, and then maintain this dose. MMF was started at 0.5g, 2 / d, and increased to 1.5-2.0g / d based on blood concentration. It was used continuously for 6 months and maintained at a daily dose of 0.75-1g for a total course of 2 years.

(2) Cyclophosphamide (CTX) treatment plan : Methylprednisolone and MMF treatment plan. CTX shock therapy, once a month for a total of 6 months, and then every 3 months thereafter. The total dose is <8g. After CTX treatment was completed, azathioprine was maintained for a total of 2 years.

5. A large number of proteinuria types (with minor lesions)

Prednisone is treated regularly.

6. Lots of proteinuria

Low protein diet, treated with triptolide, emodin, ACEI / ARB drugs.

7. Hypertension

Antihypertensive drugs with ACEI / ARB, CCB, and diuretics are selected. For cases with proteinuria> 1.5g / 24, triptolide tablets can be combined.

IgA nephropathy prognosis

Elderly patients, older patients, persistent microscopic hematuria with proteinuria, renal insufficiency, patients with IgA nephropathy have hypertension, especially severe hypertension that is difficult to control, pathological type above Lee type III The prognosis is poor.

IgA nephropathy prevention

1. Take appropriate rest and avoid strenuous exercise, but when the condition is stable, proper exercise is necessary.

2. Increase disease resistance, avoid cold, and reduce the chance of infection. Once various infections occur, you should apply powerful antibiotics in time and control the infection early.

3.IgA nephropathy prevention and treatment diet: The diet is mainly light. It is advisable to eat more fruits, vegetables and high-quality high-protein foods. Spicy, fatty and thick flavors, as well as mold products, preserved foods, and alcohol should be avoided.