IgA nephropathy, also known as Berger's disease, is the commonest glomerulonephritis.
The classical patient is a young man with haematuria after an upper respiratory tract infection.
Overall micro or macrohaematuria is the presenting feature in around 40% of cases.
Histologically there is mesangial hyperplasia and on immunofluorescence there is IgA and C3 deposition.
It is often a subclinical condition, but amongst those for whom it becomes clinically apparent there is around 20% progression to end stage renal failure at 20 years.
A poorer prognosis is associated with
- male gender (the majority of sufferers are male)
- proteinuria
- obesity
Associated conditions include
- liver cirrhosis
- coeliac disease
- IBD
- dermatitis herpetiformis
- psoriasis
- ankylosing spondylitis
Management
- Angiotensin 2 inhibitor or ACE-i
- if this fails, ?immunosupression
- in renal failure consider transplant, although IgA nephropathy recurs in the majority of grafts
Henoch Schonlein Purpura is sometimes regarded as the systemic manifestation of IgA nephropathy.
