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Primary IgA nephropathy in adults
J George1, V T Ninan, P P Thomas
1Department of Nephrology, Christian Medical College Hospital, Vellore.
Insights
IgA nephropathy is a common cause of glomerulonephritis in adults. While many patients remain stable, a significant minority progress to end-stage renal disease, highlighting the need for monitoring.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- IgA nephropathy (IgAN) is a primary glomerulonephritis.
- Understanding its prevalence and clinical course is crucial for patient management.
Purpose of the Study:
- To investigate the clinical characteristics, pathological findings, and outcomes of IgA nephropathy in adults.
- To determine the progression rate to end-stage renal disease.
Main Methods:
- Retrospective analysis of 649 adult patients with primary glomerulonephritis.
- Evaluation of clinical presentation, light microscopy, and immunofluorescence findings.
- Follow-up assessment of renal function and disease progression.
Main Results:
- IgA nephropathy identified in 9.6% of patients.
- Hypertension (51.6%), renal failure (32.3%), nephrotic presentation (22.6%), and hematuria (17.7%) were common.
- Mesangial hypercellularity and matrix expansion were frequent histological findings.
- IgA deposition confirmed in all cases; C3, IgM, and IgG co-deposition observed.
- End-stage renal disease developed in 7.9% of patients during a mean follow-up of 17.3 months.
Conclusions:
- IgA nephropathy is a significant contributor to adult glomerulonephritis.
- Clinical and histological features vary, with a notable risk of progression to renal failure.
- Long-term monitoring is essential for identifying patients at risk of disease progression.
Abstract:
IgA nephropathy was found in 9.6% of 649 adults with primary glomerulonephritis. Hypertension was detected in 51.6% and renal failure in 32.3%. A nephrotic presentation was seen in 22.6% and recurrent macroscopic hematuria in 17.7%. On light microscopy, mesangial hypercellularity and an increase in mesangial matrix were frequently seen (74.2%). Immunofluorescence studies demonstrated IgA in all patients along with C3 in 61.3%, IgM in 27.4% and IgG in 11.3%. Followup was possible in 61.3% for mean period of 17.3 months. No clinical or biochemical abnormalities were detected on followup in 26.3%. Progression to end stage renal disease was noted in 7.9%.