Clinical presentation and diagnosis of IgA nephropathy
- Chee Kay Cheung, PhD, MRCP
Chee Kay Cheung, PhD, MRCP
- Clinical Lecturer
- University of Leicester, UK
- Jonathan Barratt, PhD, FRCP
Jonathan Barratt, PhD, FRCP
- Professor; Honorary Consultant Nephrologist
- University of Leicester, UK
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- Fernando C Fervenza, MD, PhD
Fernando C Fervenza, MD, PhD
- Section Editor — Glomerular Diseases
- Professor of Medicine
- Mayo Clinic College of Medicine
IgA nephropathy is the most common lesion found to cause primary glomerulonephritis throughout most developed countries of the world [1-8]. Patients may present at any age, but there is a peak incidence in the second and third decades of life. There is approximately a 2:1 male-to-female predominance in North American and Western European populations, although the sexes are equally affected among populations in East Asia.
The epidemiology, pathology, clinical features, and diagnosis of IgA nephropathy will be reviewed here. The pathogenesis, treatment, and prognosis of this disorder are discussed separately. (See "Pathogenesis of IgA nephropathy" and "Treatment and prognosis of IgA nephropathy".)
IgA nephropathy occurs with greatest frequency in East Asians and Caucasians and is relatively rare in blacks [4,6,9]. In a Chinese study of 13,519 renal biopsies, for example, IgA nephropathy constituted 45 percent of all cases of primary glomerulonephritis . However, IgA deposits may also be seen on kidney biopsy in individuals with no clinical evidence of renal disease .
The reported incidence of mesangial IgA deposition in apparently healthy individuals ranges from 3 to 16 percent [10,11]. These cases had no clinical features of nephritis but their renal biopsy was consistent with IgA nephropathy.
This observation raises three important points:
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- Oxford classification of IgA nephropathy
- CLINICAL FEATURES
- CLINICAL ASSOCIATIONS
- Cirrhosis and other forms of severe liver disease
- Celiac disease
- HIV infection
- Minimal change disease and membranous nephropathy
- Granulomatosis with polyangiitis (Wegener's)
- Indications for renal biopsy
- Tests of limited utility
- Differential diagnosis
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- INFORMATION FOR PATIENTS