DR Medhat MRCP

Investigations:
SCr, U&E, eGFR, serum albumin, bone profile, lipid profile.
Elevated serum IgA in around 50%.
Urine microscopy for dysmorphic RBCs and red cell casts .
Elevated uPCR or uACR.
Biopsy of associated skin rash, if present, may show IgA deposition on IF.
Renal biopsy (diagnostic) .
Histology:
LM : mesangial hypercellularity& mesangeal matrix .
IF : confirms mesangial IgA deposits with C3. Possible co-deposition of IgG and IgM.
EM : mesangial deposits near the paramesangial GBM.
Prognosis :
25-50 % of patients develop ESRD, the rest enter remission or persistant
proteinuria/hematuria.
Poor prognostic features :
1) Male gender
NB : Frank hematuria is a good prognostic features
2) Smoking.
3) Dyslipidemia.
4) Impaired renal function.
5) Heavy proteinuria (>3g/day) not . by ACE-I &/or ARBs
6) Difficult to control hypertension.
7) Significant tubulointerstitial fibrosis and glomerulosclerosis on renal biopsy.
8) Rapidly progressive crescentic IgAN.
9) ACE genotype DD.
Management
The treatment of IgAN is unsatisfactory.
Prevention of progressive renal impairment is the key therapeutic goal.
Management depends on renal risk stratification of the patient as follows :
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