How to determine the stages of IgA nephropathy?

Written by Ji Kang
Nephrology
Updated on January 16, 2025
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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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Written by Ji Kang
Nephrology
1min 7sec home-news-image

IgA nephropathy is a disease.

IgA nephropathy is the most common type of primary glomerular disease, caused by the deposition of IgA-dominant immunoglobulins in the glomerular mesangial area. It has a short latency period, with symptoms appearing early. Clinical manifestations of IgA nephropathy are diverse, with approximately 40%-50% of patients experiencing macroscopic hematuria hours to two days after precursor symptoms such as upper respiratory tract infections, and some patients also suffer from severe back pain and abdominal pain. About 30%-40% of patients only present with asymptomatic hematuria or proteinuria. Approximately 5%-20% of patients exhibit severe edema and substantial proteinuria, showing symptoms of nephrotic syndrome. At the onset of the disease, about 10% of patients also have hypertension. As the disease progresses, those with hypertension can exceed 40%. Less than 10% of patients may experience acute renal failure.

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Written by Li Liu Sheng
Nephrology
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How to treat IgA nephropathy?

IgA nephropathy has many clinical manifestations and pathological types, and the treatment of IgA nephropathy is selected based on different clinical manifestations and pathological types. Usually, for patients with IgA nephropathy who only show microscopic hematuria, drug treatment is not necessary. They only need to regularly monitor routine urine tests, kidney function, and blood pressure changes in daily life, and must avoid using medications that are toxic to the kidneys. If the patient presents with gross hematuria related to tonsillar infection, tonsillectomy is recommended. If an IgA nephropathy patient has increased urinary protein, and the 24-hour urinary protein quantification exceeds 1g, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers can be used. Of course, for patients with significant proteinuria, steroids or immunosuppressants may also be used. In addition, IgA nephropathy patients can also be treated with traditional Chinese medicine. (Medication use should be under the guidance of a professional doctor.)

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Written by Li Liu Sheng
Nephrology
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Can IgA nephropathy hematuria heal itself?

Hematuria is the most common clinical manifestation of IgA nephropathy. As IgA nephropathy is a chronic disease and not self-healing, the hematuria associated with it does not resolve on its own and will repeatedly occur or exacerbate. Typically, patients with IgA nephropathy exhibit microscopic hematuria when the condition is stable. However, gross hematuria may appear during physical exertion or respiratory infections, such as pharyngitis. In addition, IgA nephropathy patients also show increased urinary protein and can experience elevated blood pressure. Back pain is also a common clinical manifestation in patients with IgA nephropathy, so there is no need to be overly concerned about the presence of blood in the urine.

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Written by Hu Lin
Nephrology
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IgA kidney disease's etiology

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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Written by Zhou Qi
Nephrology
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Why doesn't IgA nephropathy cause swelling?

IgA nephropathy refers to the abnormal deposition of IgA immunoglobulin in the glomeruli of patients, which causes an inflammatory response and damages the glomerular capillaries. The extent of this damage varies, so not all patients will experience swelling. If the condition is severe, causing significant proteinuria, patients may develop hypoproteinemia and consequent decrease in plasma colloidal osmotic pressure, leading to swelling. If renal failure has occurred, the kidneys' ability to excrete water decreases, which can also cause swelling. Some patients may experience swelling due to damage to the renal tubules, which increases the reabsorption capacity for water. Otherwise, patients may not show obvious swelling, such as those with only mild proteinuria and hematuria, whose clinical symptoms are not pronounced.