IgA kidney disease's etiology

Written by Hu Lin
Nephrology
Updated on September 07, 2024
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IgA nephropathy can be divided into primary and secondary IgA nephropathy. Secondary IgA nephropathy includes, for example, lupus nephritis, allergic purpura nephritis, liver disease-related kidney damage, rheumatoid arthritis kidney damage, and so on. The etiology of primary IgA nephropathy is mainly due to the deposition of a type of immunoglobulin, IgA, in the mesangial area of the glomeruli, leading to a series of immune responses, which in turn cause inflammatory damage, resulting in a chronic glomerulonephritis. This form of IgA nephropathy is mainly related to mucosal immune defense, meaning it is linked to certain infectious factors. Additionally, some patients have high reactivity of their mucosa to certain food antigens, which leads to a series of immune-mediated inflammatory responses.

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Can IgA nephropathy affect menstruation?

IgA nephropathy is a very common glomerular disease in the department of nephrology and is often seen in adolescents, affecting both males and females. Generally, IgA nephropathy itself does not affect menstruation. However, if hormones or immunosuppressants are used during the treatment of IgA nephropathy, it may affect the menstrual cycle or the amount of menstrual flow. In other words, some patients with IgA nephropathy may experience delayed menstruation, reduced menstrual flow, or even increased menstrual flow while using these medications. Therefore, for patients with abnormal menstruation, it is important to report to the doctor in a timely manner and to actively undergo relevant examinations to rule out other causes. If there are no other factors, medication treatment can continue while regularly monitoring kidney function and changes in routine urine tests.

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How to determine the stages of IgA nephropathy?

IGA nephropathy has different grading methods, such as Lee grading and Hass grading. Both classify the pathological changes of IGA nephropathy into five stages, with similar descriptions. According to the Lee grading: Grade 1: Most glomeruli are normal, with occasional mild mesangial widening or without cellular proliferation, and no tubulointerstitial changes. Grade 2: Glomeruli show focal mesangial proliferation, with no tubulointerstitial changes. Grade 3: Glomeruli exhibit diffuse mesangial proliferation, with occasional segmental focal lesions, rare crescents, and adhesions, focal interstitial edema, and rare cellular infiltration. Grade 4: Glomeruli show diffuse severe mesangial proliferation and sclerosis, partial or segmental glomerulosclerosis, crescent formation observed but less than 45%, tubular atrophy, interstitial infiltration. Grade 5: The nature of the lesions is similar to grade 4 but more severe. Crescent formation in glomeruli is greater than 45%.

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How to deal with swollen feet in IgA nephropathy?

IgA nephropathy is a pathological type of chronic glomerulonephritis, and patients are prone to edema. The treatment of this edema is divided into two aspects: First, it is necessary to control the condition of IgA nephropathy itself. If there is a significant amount of proteinuria or a large formation of crescents in the glomeruli, the patient may need to use steroids and immunosuppressive agents to control the inflammatory response in the glomeruli. This is the fundamental approach to treating this disease. Second, symptomatic treatment is applied. For mild edema, no special treatment is generally required. However, for severe edema or even systemic edema, it may be appropriate to use diuretics to increase urine output, which can alleviate the patient's edema. However, this is not a solution to the root cause of the problem.

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IgA nephropathy manifestations

IgA nephropathy is a pathological type of chronic glomerulonephritis. The clinical manifestations of this disease are diverse, with the typical clinical presentation of IgA nephropathy being hematuria, especially visible hematuria following a cold. However, patients may also exhibit other features, such as significant amounts of urinary protein. In some cases, this can reach the level of 3.5g in a 24-hour urine protein quantification. Patients may experience edema, such as swelling in the lower limbs, eyelids, etc. There could also be clinical presentations of high blood pressure, rapid progression of renal failure, and other symptoms.

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How is IgA nephropathy diagnosed?

The diagnosis of IgA nephropathy relies on pathological examination. The name "IgA nephropathy" itself is a term used in immunopathological diagnosis, describing a type of chronic glomerulonephritis. There are many reasons that can cause inflammatory reactions in the kidneys, and the underlying mechanisms of the disease vary. Specifically, IgA nephropathy refers to the abnormal deposition of IgA immune complexes in the mesangial areas of the glomeruli. Therefore, a pathological examination is necessary for diagnosis. Typically, under a light microscope, proliferation of mesangial cells and widening of the mesangial areas can be observed. Additionally, immunofluorescence testing is conducted to detect a large presence of IgA immune complexes in the glomerular mesangial areas, confirming the diagnosis of IgA nephropathy.