IgA Nephropathy

IgA nephropathy is the most common primary glomerular disease, refers to the glomerular mesangial area with IgA or IgA deposition mainly with or without other immunoglobulin deposition in the glomerular mesangial area Primary glomerulopathy. Types of lesions include focal segmental lesions, capillary proliferative lesions, mesangial proliferative lesions, crescentic lesions and sclerosing lesions. The clinical manifestations of recurrent nausea hematuria or microscopic hematuria, may be associated with varying degrees of proteinuria, some patients can be severe high blood pressure or renal insufficiency.

Etiology
Unknown etiology, primary IgA nephropathy, caused by the disease of the kidney itself. Secondary IgA nephropathy is caused by diseases other than kidney, such as purpura nephritis, HIV infection, seronegative spondyloarthritis, tumor, leprosy, liver disease, familial IgA nephropathy, and the like.

Clinical manifestations
More in the upper respiratory tract infection 1 to 3 days after the recurrence of nausea hematuria, for several hours to several days after the mirror can be turned into hematuria, may be associated with abdominal pain, low back pain, muscle pain or low fever, some patients found in urine abnormalities , Asymptomatic proteinuria and / or microscopic hematuria, a small number of patients with persistent macroscopic hematuria and varying degrees of proteinuria, may be associated with edema and high blood pressure.

an examination
1. Immunological examination
50% of patients with elevated serum IgA levels. 37% to 75% of patients measured specific IgA-containing circulating immune complexes.
2. Urine examination
Protein urine quantification and classification of IgA nephropathy to determine the prognosis is very important. Proteinuria <1g / 24h are often mild and focal mesangial hyperplasia. Moderate to severe proteinuria mostly diffuse mesangial hyperplasia, often accompanied by crescent and glomerular sclerosis. Hematuria: urine RBC morphology was pleomorphic, suggesting that the source of hematuria is glomerular origin.
3. renal function test
Serum creatinine rose to 1.5mg / dl (132.6umol / L) for the progression of the disease. GFR <20ml / min, the pathological changes are more than Ⅲ level.

diagnosis
IgA nephropathy must be diagnosed with renal biopsy pathology, must have immunofluorescence or immunohistochemical results support. The diagnostic features are: light microscopic common diffuse mesangial proliferation or focal segmental proliferative glomerulonephritis; immunofluorescence can be seen in the mesangial area IgA or IgA-based immune complex deposition, which is the diagnosis of IgA nephropathy Logo.

treatment
The disease without special treatment, clinical manifestations and duration according to the patient, using different measures, the purpose is to protect renal function, slow down the progress of the disease. Treatment of IgA nephropathy according to clinical classification is as follows:
1. Isolated microscopic hematuria
No special treatment, regular follow-up.
2. recurrent nausea and hematuria
Lesions such as tonsillectomy can be used depending on the amount of proteinuria triple therapy (tripterygium glycosides, emodin, ACEI / ARB).
3. Urine examination abnormal type
Triple therapy (tripterygium glycosides, emodin, ACEI / ARB).
Vasculitis type
(1) MMF treatment: methylprednisolone intravenous infusion for three days, followed by prednisone 0.6mg / (kg.d), every 2 weeks to reduce 5mg / d to 10mg / d, after the maintenance of this dose. MMF to 0.5g, 2 / d began to administration, according to the plasma concentration increased to 1.5 ~ 2.0g / d, continuous use of 6 months to 0.75 ~ 1g daily dose maintenance, the total course of 2 years.
(2) cyclophosphamide (CTX) treatment: methylprednisolone with MMF treatment. CTX shock therapy, once a month for 6 months, once every 3 months. Total dose <8g. CTX treatment after the end of azathioprine maintenance, the total course of 2 years.
5. A large number of proteinuria (combined with small lesions)
Prednisone regular treatment.
6. A large number of protein urine type
Low-protein diet, the use of tripterygium glycosides, emodin, ACEI / ARB drug treatment.
Hypertension type
Select the use of ACEI / ARB, CCB, diuretics type of antihypertensive drugs, proteinuria> 1.5g / 24 cases can be combined with Tripterygium polyglycoside tablets.

Prognosis
Elderly patients with older age, persistent microscopic hematuria associated with proteinuria, renal insufficiency, IgA nephropathy in patients with high blood pressure, especially difficult to control the severity of hypertension, pathological type in the Lee class Ⅲ level above Poor prognosis.

prevention
1. appropriate rest, to avoid strenuous exercise, but the condition is stable, the appropriate exercise is necessary.
2. To increase the resistance to disease, to avoid cold, reduce the chance of infection, once the emergence of various infections, should be timely application of strong antibiotics and early control of infection.
3.IgA kidney disease control diet: diet mainly light, should eat more fruits, vegetables and high-quality high-protein foods, ban spicy, Feigan thick taste, and mildew products, pickled food, Ji Jiu.