Summary
Definition
History and exam
Key diagnostic factors
- hematuria
Other diagnostic factors
- proteinuria
- hypertension
- edema
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
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
Tests to consider
- flexible cystoscopy
- skin biopsy
Treatment algorithm
low risk of progression
medium risk of progression
high risk of progression
acute kidney injury
Contributors
Authors
Jonathan Barratt, PhD, FRCP
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.
See Cheng Yeo, MBBS, M.Med (Int Med), FRCP (London), MD
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.
Acknowledgements
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
Richard Lafayette, MD
Associate Professor of Medicine
Nephrology Division
Stanford University Medical Center
Stanford
CA
Disclosures
RL declares that he has no competing interests.
Alan Salama, MA, MBBS, PhD, FRCP
Professor of Nephrology
UCL Centre for Nephrology
Royal Free Hospital
London
UK
Disclosures
AS declares that he has no competing interests.
References
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.
Differentials
- IgA vasculitis (previously known as Henoch-Schönlein purpura [HSP])
- Thin glomerular basement membrane disease
- Alport syndrome
More DifferentialsGuidelines
- KDIGO 2021 clinical practice guidelines for the management of glomerular diseases
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer