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IgA nephropathy

Last updated: March 29, 2021

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IgA nephropathy (Berger disease) is the most common primary glomerulonephritis worldwide. It most frequently affects males in the second to third decades of life. Clinical manifestations are usually triggered by upper respiratory tract or gastrointestinal infections and include gross hematuria and flank pain. In some cases, it may present as rapidly progressive glomerulonephritis (RPGN). Urinalysis of asymptomatic patients often shows persistent microhematuria and minor proteinuria, while more severe cases may manifest with recurrent episodes of nephritic syndrome. A kidney biopsy is indicated in patients with signs of severe or progressive disease to make a definitive diagnosis. Treatment consists of measures to slow the progression of the disease (e.g., ACE inhibitors) as well as immunosuppressive therapy in more severe cases. Even with the appropriate treatment, up to 50% of patients progress to end-stage renal disease within 20–25 years.

IgA nephropathy is the most common primary glomerulonephritis in adults. [1]

  • Peak incidence: second to third decades of life [2]
  • Sex: > (2:1) [3]
  • Ethnicity: more common in the Asian population (worldwide) [4]

Epidemiological data refers to the US, unless otherwise specified.

The course of the disease is highly variable and can manifest in the following forms:

IgA nephropathy and Henoch-Schonlein purpura (HSP) are both IgA-mediated vasculitides triggered by a mucosal infection. HSP most commonly occurs in children < 10 years of age and affects multiple organ systems (palpable purpura, abdominal pain, arthralgia). IgA nephropathy is limited to the kidneys and typically affects adults.

References:[6][7][8][9][10][11]

Diagnosis is based on clinical presentation and laboratory results. In some cases, renal biopsy may be indicated to confirm the diagnosis.

The renal manifestation of Henoch-Schönlein purpura is pathologically the same as IgA nephropathy.

The differential diagnoses listed here are not exhaustive.

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  2. Barratt J, Feehally J. Immunoglobulin A Nephropathy and Related Disorders. Elsevier ; 2014 : p. 185-192
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  8. Geddes CC, Rauta V, Gronhagen-Riska C, Bartosik LP, Jardine AG, Ibels LS, Pei Y, Cattran DC.. A tricontinental view of IgA nephropathy.. Oxford Academic. 2003; 18 (8): p.1541-8. doi: 10.1093/ndt/gfg207 . | Open in Read by QxMD
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  10. Lewis EJ, Carpenter CB, Schur PH.. Serum complement component levels in human glomerulonephritis.. Ann Intern Med. 1971; 75 (4): p.555-60.
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  12. Goldman L, Schafer AI. Goldman-Cecil Medicine, 25th Edition. Elsevier ; 2016