IgA nephropathy

Background

• Nephritic syndrome, form of chronic glomerulonephritis caused by deposition of IgA immune complexes in glomeruli
• Slowly progressive

Clinical Features

• Hematuria, persistent or recurrent, macroscopic or asymptomatic microscopic
  • Gross hematuria initially begins a few days after febrile illness, thus mimicking acute postinfectious glomerulonephritis
• Mild proteinuria
• +/- flank pain, fever during acute episodes
• Usually slowly progressive, but rapidly progressive glomerulonephritis manifests initially in <10% of patients

Rapidly progressive GN is the initial manifestation in < 10% of patients.

Differential Diagnosis

Hematuria

• Pediatric patients
  • Glomerulonephritis
  • UTI
  • Congenital urinary tract anomaly
• Younger adults
  • UTI
  • Nephrolithiasis
• Older adults
  • UTI
  • Neoplasm
  • BPH
• Any age
  • Schistosomiasis (most common cause worldwide)

Evaluation

• UA
  • Hematuria, usually with dysmorphic RBCs, occasional RBC casts
  • Mild proteinuria
• BMP
  • Creatinine usually normal unless progressed
• Definitive diagnosis with renal biopsy

Management

• Usually no treatment required in ED
• ACEi or ARB for hypertension, Cr >1.2, or macroalbuminuria
• Corticosteroids and/or cyclophosphamide for advanced or rapidly progressive disease

Disposition

Discharge

See Also

• Glomerulonephritis