IgA Nephropathy

by Carlo Raj, MD

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    00:01 Now, the first primary nephritic type of glomerular disease that we’ll take a look at is IgA glomerulopathy or IgA nephropathy.

    00:10 All the same thing, aka Berger.

    00:13 What I wish to bring to attention is there is another condition in pathology that we call Wegener’s disease.

    00:18 Wegener’s disease is going to be associated with the small vessel disease or vasculitis.

    00:25 Completely different discussion. That’s point number one.

    00:28 Many students tend to get that confused between Berger’s and Buerger’s.

    00:33 They are two different conditions.

    00:34 One has nothing to do with the other.

    00:37 Berger has to be dealing with IgA.

    00:42 This IgA is then going to deposit, I’ll tell you in a second but before I get there this IgA could also be found on another important disease, that is an important differential that could also be associated with the kidney.

    00:56 Do you remember which one? What if I told you there’s IgA deposition in the kidney, or in the glomeruli and there’s also palpable purpura in a young child in the lower extremities or perhaps in the buttocks.

    01:08 That’s called Henoch-Schonlein Purpura and a better name now clinically, and it has been for quite some time called IgA vasculopathy.

    01:17 Are we clear? Be careful. This is only nephropathy.

    01:21 Berger, most commonly nephropathy worldwide.

    01:25 Meaning to say majority of nephritic and also take a look, nephrotic 5% of the time.

    01:31 Worldwide this is the one that you definitely wanna know.

    01:34 Next, it affects children and adults.

    01:37 Next, increase mucosal synthesis and decrease clearance of IgA.

    01:42 Thus you’ll find 50% of your population in which the IgA levels are elevated in the serum.

    01:49 Next, there is focal proliferative glomerulopathy.

    01:53 And this IgA’s is then going to deposit on the mesangium.

    01:57 May I ask you something? So therefore, which one of the biopsy patterns would most come in handy here, do you think? It will be the immunofluorescence in which in the mesangium you find green pools.

    02:09 Meaning to say immunoglobulin is accumulating in the mesangium resulting green pool type of deposition.

    02:16 So mesangium IgA is what you're paying attention to these immune-complex that deposit to the granular immunofluorescence it ends up being in the mesangium you're going to activate the complement pathway.

    02:27 Complement, that alternative.

    02:28 Overlapping features is with Henoch-Schonlein Purpura may occur.

    02:34 But the difference is with IgA here and Henoch-Schonlein, you pay attention to purpura and HSP, Henoch-Schonlein, the purpura representing the involvement of your blood vessel.

    02:44 In Berger, that is not the case.

    02:47 But in HSP, could you involve the blood vessel and the kidney? Yes, you can.

    02:51 What’s the immunoglobulin? AAA.

    02:53 Episodic bouts of hematuria.

    02:56 I need you to pay attention to this description, episodic.

    02:59 That is big in medicine.

    03:01 You can have episodic type of events with hypertension, That’s pheochromocytoma.

    03:07 You could have episodic events of jaundice, that’s Gilbert or Gilbert’s syndrome.

    03:13 You have episodic bouts of hematuria.

    03:15 Higher the differential, you should be thinking about IgA nephropathy.

    03:19 Usually following a upper respiratory tract infection.

    03:24 Highlight that in your head.

    03:25 Hyper or upper respiratory type of infection, you don’t have this latent period.

    03:31 For example, say that you had sore throat or pharyngitis.

    03:34 Two to four weeks later, that would not be Berger.

    03:38 Two to four weeks later, would be PSGN, with hematuria.

    03:44 If we’re talking days after a sore throat or pharyngitis, that would be Berger IgA nephropathy.

    03:53 Did you hear what I just said? And how important it is based on that history to come up with two differentials and which one will be more likely differential if you had what's known as synpharyngitic.

    04:06 Synpharyngitic basically means the days after a pharyngitic episode, upper respiratory tract infection, your patient now has developed hematuria.

    04:17 Slow progression to chronic renal failure.

    04:20 Only 40-50% at a time but it’s slow progression.

    04:22 Many times you can have kidney damage not necessarily going into chronic renal failure.

    04:27 Corticosteroids, decrease proteinuria, treat the hypertension which you must do.

    04:32 Remember, especially for the child, these are the things you wanna keep in mind.

    About the Lecture

    The lecture IgA Nephropathy by Carlo Raj, MD is from the course Glomerulonephritis.

    Author of lecture IgA Nephropathy

     Carlo Raj, MD

    Carlo Raj, MD

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