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IgA nephropathy

Last reviewed: 1 Apr 2025
Last updated: 01 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • hematuria
Full details

Other diagnostic factors

  • proteinuria
  • hypertension
  • edema
Full details

Risk factors

  • family history of IgAN
  • male sex
  • age 20 to 30 years
  • Asian/white/native American ancestry
  • IgA vasculitis
  • chronic liver disease
  • HIV infection
Full details

Diagnostic tests

1st tests to order

  • urinalysis
  • urine microscopy and culture
  • basic biochemistry, including estimated glomerular filtration rate (GFR)
  • C3 and C4 complement levels
  • kidney ultrasound
  • computed tomography (KUB)
  • kidney biopsy
Full details

Tests to consider

  • flexible cystoscopy
  • skin biopsy
Full details

Treatment algorithm

ONGOING

low risk of progression

medium risk of progression

high risk of progression

acute kidney injury

Contributors

Authors

The Mayer Professor of Renal Medicine

Department of Cardiovascular Sciences

University of Leicester

Honorary Consultant Nephrologist

John Walls Renal Unit

Leicester General Hospital

UK

Disclosures

JB has consultancies with Alnylam, argenx, Astellas, Calliditas, Chinook, Dimerix, Novartis, Omeros, Travere Therapeutics, Vera Therapeutics and Visterra. He is also an author of a number of references cited in this topic.

Adjunct Assistant Professor

Head & Senior Consultant

Department of Renal Medicine

Tan Tock Seng Hospital

Singapore

Disclosures

SCY is an author of a reference cited in this topic.

Professor Jonathan Barratt and Dr See Cheng Yeo would like to gratefully acknowledge Dr Hani Bleibel and Dr Chike Nzerue, previous contributors to this topic.

Disclosures

HB and CN declare that they have no competing interests.

Peer reviewers

Associate Professor of Medicine

Nephrology Division

Stanford University Medical Center

Stanford

CA

Disclosures

RL declares that he has no competing interests.

Professor of Nephrology

UCL Centre for Nephrology

Royal Free Hospital

London

UK

Disclosures

AS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Wyatt RJ, Julian BA. IgA nephropathy. N Engl J Med. 2013 Jun 20;368(25):2402-14. Abstract

Trimarchi H, Barratt J, Cattran DC, et al; IgAN Classification Working Group of the International IgA Nephropathy Network and the Renal Pathology Society; Conference Participants. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017 May;91(5):1014-21. Abstract

Barratt J, Feehally J. Primary IgA nephropathy: new insights into pathogenesis. Semin Nephrol. 2011 Jul;31(4):349-60. Abstract

Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021 Oct;100(4s):S1-S276.Full text  Abstract

Lv J, Zhang H, Wong MG, et al; TESTING Study Group. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA. 2017 Aug 1;318(5):432-42. Abstract

Rauen T, Eitner F, Fitzner C, et al. Intensive supportive care plus immunosuppression in IgA nephropathy. N Engl J Med. 2015 Dec 3;373(23):2225-36.Full text  Abstract

Tumlin JA, Hennigar RA. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol. 2004 May;24(3):256-68. Abstract

Tumlin JA, Hennigar RA. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol. 2004 May;24(3):256-68. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • IgA nephropathy images
  • Differentials

    • IgA vasculitis (previously known as Henoch-Schönlein purpura [HSP])
    • Thin glomerular basement membrane disease
    • Alport syndrome
    More Differentials
  • Guidelines

    • KDIGO 2021 clinical practice guidelines for the management of glomerular diseases
    More Guidelines
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