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==Overview==
==Overview==
==Laboratory Findings==
==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.<ref name="pmid11576875">{{cite journal| author=Bartosik LP, Lajoie G, Sugar L, Cattran DC| title=Predicting progression in IgA nephropathy. | journal=Am J Kidney Dis | year= 2001 | volume= 38 | issue= 4 | pages= 728-35 | pmid=11576875 | doi=10.1053/ajkd.2001.27689 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11576875  }} </ref> 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.
===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 AKI and macroscopic hematuria persist for at least 5 days since onset of kidney injury.


==References==
==References==

Revision as of 08:43, 8 November 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory Findings

Initial Evaluation

  1. Assess all patients with biopsy-proven IgA nephropathy for secondary causes to rule out common causes of secondary IgA nephropathy
    1. Viral serologies: HIV, HBV, HCV
    2. Liver function tests
    3. Electrophoresis of serum immunoglobulins
  2. Assess the risk of progression and prognosis by the following parameters at diagnosis and at follow-up:
    1. Blood pressure measurement
    2. Serum creatinine to estimate glomerular filtration rate (GFR)
    3. Proteinuria
    4. Pathological features

A kidney biopsy is to be considered only if signs of AKI and macroscopic hematuria persist for at least 5 days since onset of kidney injury.

References

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