About 50% of patients with IgA nephropathy present with recurrent episodes of visible haematuria after an upper respiratory tract infection or gastroenteritis; approximately one third of patients have invisible haematuria and mild proteinuria.
Less than 10% present with either nephrotic syndrome or rapidly progressive glomerulonephritis.
Acute or chronic kidney failure may develop.
Kidney biopsy is required for definitive diagnosis.
Renin-angiotensin system inhibitors are widely used to reduce proteinuria, particularly if hypertension and/or proteinuria is present, and they have been shown to help preserve kidney function.
The value of immunosuppression in IgAN is widely debated. There is some evidence that early corticosteroid treatment may reduce the severity of proteinuria and delay kidney function deterioration in people with moderate proteinuria, but this may be associated with serious adverse effects.
IgA 肾病 (IgAN) 的定义为肾小球系膜区存在 IgA 沉积或以 IgA 为主的免疫沉积物，经常伴有 C3 和 IgG，与不同严重程度的系膜增生性肾小球肾炎有关。这种常见肾小球肾炎的病因仍然未知。临床表现差异很大。患者常表现为复发性肉眼血尿（通常发生在上呼吸道感染或胃肠炎之后）或无症状的镜下血尿，伴或不伴蛋白尿。不太常见的是，患者可能表现为明确的慢性肾脏疾病、肾病综合征、恶性高血压或急进性肾小球肾炎。
- IgAN 家族史。
- 年龄为 20 岁至 30 岁
- IgA 血管炎
- HIV 感染
- 基础生化检查，包括估算的肾小球滤过率 (GFR)
- C3 和 C4 补体水平
- kidney ultrasound
- 计算机体层摄象术 (KUB)
- kidney biopsy
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
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
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.
HB and CN declare that they have no competing interests.
Richard Lafayette, MD
Associate Professor of Medicine
Stanford University Medical Center
RL declares that he has no competing interests.
Alan Salama, MA, MBBS, PhD, FRCP
Professor of Nephrology
UCL Centre for Nephrology
Royal Free Hospital
AS declares that he has no competing interests.