IgA nephropathy laboratory findings: Difference between revisions

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Latest revision as of 13:41, 4 June 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

There are no specific and sensitive diagnostic laboratory findings associated with IgA nephropathy. However all patients with biopsy-proven IgA nephropathy are assessed for secondary causes to rule out common causes of secondary IgA nephropathy. The viral serologies for HIV, HBV, HCV, Liver function tests, and Electrophoresis of serum immunoglobulins are performed. Blood pressure measurement, serum creatinine to estimate glomerular filtration rate , Proteinuria, and pathological features are monitored to assess the risk of progression of the disease.

Laboratory Findings

There are no specific and sensitive diagnostic laboratory findings associated with IgA nephropathy.^[1]^[2]
Some patients with IgA nephropathy may have elevated concentration of serum total IgA.
- There is not enough evidence of serum total IgA concentration for the measurement of the severity or activity of IgA nephropathy.
The urinary Immunoglobulins are not distinctive in IgA nephropathy.

Initial Evaluation

Assess all patients with biopsy-proven IgA nephropathy for secondary causes to rule out common causes of secondary IgA nephropathy
- Viral serologies:
  - HIV
  - HBV
  - HCV
- Liver function tests
- Electrophoresis of serum immunoglobulins
Assess the risk of progression and prognosis by the following parameters at diagnosis and at follow-up:
- Blood pressure measurement
- Serum creatinine to estimate glomerular filtration rate (GFR)
- Proteinuria
- Pathological features
A kidney biopsy is to be considered only if signs of acute kidney injury and macroscopic hematuria persist for at least 5 days since the onset of kidney injury.

References

↑ Galla JH (February 1995). "IgA nephropathy". Kidney Int. 47 (2): 377–87. PMID 7723227.
↑ Donadio JV, Grande JP (September 2002). "IgA nephropathy". N. Engl. J. Med. 347 (10): 738–48. doi:10.1056/NEJMra020109. PMID 12213946.

Template:WH Template:WS

[pmid7723227-1] Galla JH (February 1995). "IgA nephropathy". Kidney Int. 47 (2): 377–87. PMID 7723227.

[pmid12213946-2] Donadio JV, Grande JP (September 2002). "IgA nephropathy". N. Engl. J. Med. 347 (10): 738–48. doi:10.1056/NEJMra020109. PMID 12213946.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{IgA nephropathy  }}
+{{IgA nephropathy}}
-{{CMG}}
+{{CMG}}; {{AE}}{{SH}}
 ==Overview==
+There are no specific and sensitive diagnostic laboratory findings associated with IgA nephropathy. However all patients with biopsy-proven IgA nephropathy are assessed for secondary causes to rule out common causes of secondary IgA nephropathy. The viral serologies for [[Human Immunodeficiency Virus (HIV)|HIV]], [[HBV]], [[HCV]], [[Liver function tests]], and [[Electrophoresis]] of [[serum]] [[Antibody|immunoglobulins]] are performed. [[Blood pressure]] measurement, [[Creatinine|serum creatinine]] to estimate [[Glomerular filtration rate|glomerular filtration rate]] , [[Proteinuria]], and pathological features are monitored to assess the risk of progression of the disease.
 ==Laboratory Findings==
-In children and younger adults, the history and association with respiratory infection can raise the suspicion of IgA nephropathy directly. A [[urinalysis]] will show [[red blood cells]], usually as red cell [[ urinary casts]]. [[Proteinuria]], usually less than 2 grams per day, also may be present. Other [[renal]] causes of isolated hematuria include [[thin basement membrane disease]] and [[Alport syndrome]], the latter being a [[hereditary disease]] associated with [[hearing impairment]]. A kidney [[needle aspiration biopsy|biopsy]] is necessary to confirm the diagnosis. The biopsy specimen shows proliferation of the [[mesangium]], with IgA deposits on [[immunofluorescence]] and [[electron microscopy]]. However, all patients with isolated [[microscopic hematuria]] (i.e. without associated proteinuria and with normal [[kidney function]]) are not usually biopsied since this is associated with an excellent [[prognosis]].
-Other [[blood test]]s done to aid in the diagnosis include [[C-reactive protein|CRP]] or [[erythrocyte sedimentation rate|ESR]], [[Complement system|complement]] levels, [[Anti-nuclear antibody|ANA]], ANCA and [[lactate dehydrogenase|LDH]]. [[Protein electrophoresis]] and [[antibody|immunoglobulin]] levels can show increased IgA1 in 30% to 50% of all patients. may be normal or reduced. Tests such as [[electrolyte]]s, [[renal function]] ([[creatinine]], [[urea]]), total protein, [[serum albumin]] help in establishing the [[prognosis]]. Other tests such as [[bleeding time]], [[full blood count]], [[Prothrombin time|PT]] and [[Partial thromboplastin time|PTT]] are done before performing a biopsy.
+*There are no specific and sensitive diagnostic laboratory findings associated with IgA nephropathy.<ref name="pmid7723227">{{cite journal |vauthors=Galla JH |title=IgA nephropathy |journal=Kidney Int. |volume=47 |issue=2 |pages=377–87 |date=February 1995 |pmid=7723227 |doi= |url=}}</ref><ref name="pmid12213946">{{cite journal |vauthors=Donadio JV, Grande JP |title=IgA nephropathy |journal=N. Engl. J. Med. |volume=347 |issue=10 |pages=738–48 |date=September 2002 |pmid=12213946 |doi=10.1056/NEJMra020109 |url=}}</ref>
+*Some patients with IgA nephropathy may have elevated concentration of serum total IgA.
+**There is not enough evidence of [[serum]] total [[Immunoglobulin A|IgA]] concentration for the measurement of the severity or activity of IgA nephropathy.
+*The urinary [[Immunoglobulins]] are not distinctive in IgA nephropathy.
+===Initial Evaluation===
+*Assess all patients with biopsy-proven IgA nephropathy for secondary causes to rule out common causes of secondary IgA nephropathy
+**Viral serologies:
+***[[Human Immunodeficiency Virus (HIV)|HIV]]
+***[[HBV]]
+***[[HCV]]
+**[[Liver function tests]]
+**[[Electrophoresis]] of [[serum]] [[Antibody|immunoglobulins]]
+* Assess the risk of progression and prognosis by the following parameters at diagnosis and at follow-up:
+**[[Blood pressure]] measurement
+**[[Creatinine|Serum creatinine]] to estimate [[Glomerular filtration rate|glomerular filtration rate (GFR)]]
+**[[Proteinuria]]
+**Pathological features
+*A kidney biopsy is to be considered only if signs of [[acute kidney injury]] and [[macroscopic]] [[hematuria]] persist for at least 5 days since the onset of kidney injury.
 ==References==
 {{reflist|2}}