What is IGA nephropathy?

IgA nephropathy is an immune complex characterized by IgA deposition in the glomerular mesangial area. Glomerulonephritis is the most common primary glomerular disease in the world and is the main type of chronic kidney disease in China. Due to renal biopsy is not popular, accounting for about 40% of my primary glomerular disease.

In the past that IgA、 nephropathy is a good prognosis of the disease, it is clear IgA nephropathy is a progressive disease, every 10 years after the onset of about 20% of patients progress to chronic renal failure, IgA nephropathy is still chronic maintenance hemodialysis in China The first primary disease (mostly foreign kidney disease). Therefore, we should pay attention to IgA nephropathy in patients with early diagnosis and treatment, as far as possible to delay the deterioration of renal function in patients with IgA nephropathy, reduce the incidence of uremia.
Diagnosis of IgA nephropathy
IgA nephropathy in the clinical manifestations of hematuria and varying degrees of proteinuria, and other clinical manifestations of nephritis is not essentially different, so the clinical performance is difficult to make a definite diagnosis. IgA nephropathy must be diagnosed by renal biopsy. We used to think that many of the occult nephritis, in fact, done after renal biopsy confirmed to be mostly IGA nephropathy.
1, how to choose renal biopsy cases
Most kidney doctors in Europe and Europe advocate renal biopsy for patients with persistent urinary protein greater than 1 g / 24 h. There are scholars in the domestic analysis of more than 1,000 cases of IgA nephropathy clinical pathology found that if according to this standard may be missed some need to actively treat patients. Because there are a lot of urine protein 0.5 g / 24 h or so patients have moderate (Lee grade grade Ⅲ) of the pathological damage. Therefore, the idea of ​​renal biopsy in the more mature hospital, as long as persistent protein> 0.5 g / 24 h with microscopic hematuria, you can consider renal biopsy. For early diagnosis, early treatment, maintenance of normal and stable renal function. (Simple microscopic hematuria is not necessary renal biopsy).
Although the clinical manifestations of IgA nephropathy lack specificity, but after the onset of cold or tonsillitis recurrence of gross hematuria, and serum IgA / C3 ratio increased (> 3) should be highly suspected IgA nephropathy.
2, IgA nephropathy landmark pathological changes
The landmark pathological changes of IgA nephropathy are the deposition of IgA in the glomerular mesangial area. Most patients at the same time with C3, IgG, IgM deposition. IgA nephropathy changes a variety of light, the most common for mesangial proliferation, can also be expressed as almost normal "mild lesions", or different parts (inside and outside the capillaries), varying degrees of proliferation, sclerosis. In the naked eye hematuria with progressive renal dysfunction in renal biopsy specimens often have crescent formation, IgA nephropathy crescent most of the semi-crescent within half a week. Interstitial tubule lesions were not significantly different from other progressive glomerulonephritis.
Our study shows that the incidence of renal artery disease in IgA nephropathy is higher than that in non-IgA mesangial proliferative glomerulonephritis and idiopathic membranous nephropathy, and the incidence of nephrotic arterial disease is high and the incidence of hyaline degeneration is high. Electron microscopy of IgA nephropathy is mainly manifested as deposition of electron dense matter in mesangial and parietal cells.
3, IgA nephropathy treatment
IgA nephropathy pathogenesis is complex, involving more factors, so far, there is no treatment of IgA nephropathy special effects measures. As the prognosis of IgA nephropathy mainly with hypertension, a large number of proteinuria, renal dysfunction, glomerular sclerosis, interstitial fibrosis and renal arteriosclerosis related, so the treatment of IgA nephropathy should be based on the severity of these indicators Treatment, to take individualized grading therapy.
Treatment principles:
① to prevent and control infection; ② control of blood pressure in a reasonable range, that is, according to the level of proteinuria control blood pressure; ③ the use of Chinese and Western medicine control proteinuria; ④ protect renal function; ⑤ avoid fatigue, dehydration and renal toxicity drugs; Regular review and so on.
Commonly used treatments include:
Angiotensin converting enzyme inhibitors (ACEI, such as Lodinxin, Mono) and angiotensin receptor antagonists (ARB, such as Kesuya, Daiwen) and other antihypertensive drugs, glucocorticoids and other immunosuppressive agents , Anticoagulant antiplatelet aggregation and promote fiber-soluble drugs, including traditional Chinese medicine and tonsil removal.
1, for tonsil infection after nausea hematuria or urine abnormalities in patients with abnormal increase, active control of infection, early tonsil removal. Retrospective studies have shown that tonsil removal is effective for mild to moderate IgA nephropathy, which reduces the incidence of proteinuria, hematuria, and end-stage renal failure.
2, for normal blood pressure, normal renal function and urinary protein <1 g / 24 h patients, foreign scholars believe that no special treatment, only need to regularly review. But we found that these patients should be combined with renal biopsy pathological manifestations, the development of appropriate treatment options for active treatment, is conducive to complete remission of patients.
3, for urinary protein> 1 g / 24 h in patients, preferred ACEI or (and) ARB, and strive to reduce the urine protein to 0.5 g / 24 h below. If you use enough ACEI and ARB, blood pressure has been reduced to 125/75 mmHg, urine protein is still> 1 g / 24 h normal renal function patients, should be added with glucocorticoid treatment.
Hormones and other immunosuppressive agents, in addition to considering the amount of urine protein, but also consider the renal biopsy pathological changes. Significant inflammatory cell infiltration, cell proliferation, especially cell crescent formation is an indication of the use of hormones and other immunosuppressive agents. For IgA nephropathy patients with minimal changes in nephrotic syndrome, according to small lesions of nephrotic syndrome. If there has been glomerular sclerosis or fibrous crescent, the treatment will be worth the candle.
4, for IgA nephropathy in patients with hypertension, and strive to reduce blood pressure to 130/80 mmHg or even lower, if the urine protein> 1.0 g / 24 h, as far as possible to reduce blood pressure to 125/75 mmHg. Commonly used antihypertensive drugs ACEI, ARB, long-acting calcium antagonists, diuretics and β-blockers and α-blockers in the treatment of the need for further clinical evidence to support ... ...
5, for IgA nephrotic patients with renal insufficiency, should first clear the cause of renal insufficiency, for the reasons for treatment. We have significant cell proliferation and fibrin deposition in patients with moderate to severe IgA nephropathy, given ACEI combined with urokinase treatment, made to reduce proteinuria, delay the deterioration of renal function good effect.
We have a combination of traditional Chinese and Western medicine treatment of IGA kidney disease have a certain effect, especially in the control of proteinuria, the effect is more obvious, while integrated traditional Chinese and Western medicine on IGA nephropathy chronic renal impairment, you can effectively control its progress, specific Mechanism is still under study.