IgA 肾病

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.

光学显微镜检查显示局灶性或弥漫性肾小球系膜增殖和细胞外基质积聚。

免疫荧光检查显示IgA呈颗粒状弥漫性沉积在肾小球系膜。

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。[1]Wyatt RJ, Julian BA. IgA nephropathy. N Engl J Med. 2013 Jun 20;368(25):2402-14. http://www.ncbi.nlm.nih.gov/pubmed/23782179?tool=bestpractice.com