Glomerulonephritis - IgA Nephropathy (Berger's Disease)

Question 1

Epidemiology of IgA Nephropathy.

Answer 1

1. Commonest cause of primary glomerulonephritis.

2. Peak Age : 20s.

Question 2

Associated Conditions of IgA Nephropathy (3).

Answer 2

1. Alcoholic Cirrhosis.
2. Coeliac Disease.
3. Henoch-Schonlein Purpura.

Question 3

Pathophysiology of IgA Nephropathy (3).

Answer 3

1. Increased synthesis of a particular type of IgA following URTI/GI Infection.
2. Specific type forms immune complexes that are more easily lodged in the mesangium - Mesangial Deposition of IgA Immune complexes.
3. Activation of Alternative Complement Pathway.

Question 4

Clinical Presentation of IgA Nephropathy.

Answer 4

Macroscopic Haematuria in Young Person following URTI.

Question 5

Nephrotic or Nephritic Nature of IgA Nephropathy.

Answer 5

NEPHRITIC SYNDROME.

Question 6

Investigations of IgA Nephropathy.

Answer 6

1. Urinalysis and Urine MC&S (RBC, WBC and Casts).
2. Gold Standard Diagnosis : Renal Biopsy.
3. Histology : IgA Deposits and Glomerular Mesangial Proliferation.

Question 7

IgA Nephropathy vs. Post-Streptococcal Glomerulonephritis (3).

Answer 7

Post-Streptococcal Glomerulonephritis :

1. Low Complement Levels.
2. Main Symptom : Proteinuria.
3. Interval (1-2 Week) Between URTI and Onset of Renal Problems.

Question 8

Management of IgA Nephropathy.

Answer 8

1. Conservative & Follow-Up : Isolated Haematuria, No/Minimal Proteinruia and Normal GFR.
2. ACE Inhibitors : Persistent Proteinuria and Normal/Slightly Reduced GFR.
3. Active Disease (Falling GFR) or Failure to Respond to ACE Inhibitors : Immunosuppression with Corticosteroids.

Question 9

Poor Prognostic Factors of IgA Nephropathy (5).

Answer 9

1. Male.
2. Proteinuria.
3. Hypertension.
4. Smoking.
5. Hyperlipidaemia.

Question 10

Good Prognostic Factor of IgA Nephropathy.

Answer 10

Frank Haematuria.