Primary IgA nephropathy (nephritis) is an immunopathological diagnostic term characterized by recurrent episodes of gross hematuria or microscopic hematuria, which may be accompanied by varying degrees of proteinuria, with renal tissue showing predominant IgA immunoglobulin deposition.

bubble_chart Diagnosis

1. Medical history and symptoms

Most cases present with recurrent gross hematuria 1-3 days after upper respiratory tract infection (or acute gastroenteritis, peritonitis, osteomyelitis, etc.), which may persist for several hours to several days before transitioning to microscopic hematuria. This may be accompanied by abdominal pain, lumbago, muscle pain, or low-grade fever. Some patients are found to have urinary abnormalities during physical examinations, presenting as asymptomatic proteinuria and/or microscopic hematuria. A small number of patients exhibit persistent gross hematuria and varying degrees of proteinuria, which may be accompanied by edema and hypertension.

2. Physical examination findings

Most cases show no abnormal signs, but some patients may exhibit percussion tenderness in the bilateral renal regions, edema, and mild to moderate (grade II) elevation in blood pressure.

3. Auxiliary examinations

Mostly mild to moderate (grade II) proteinuria. <3g/d），血尿呈多形性、多樣性或混合性。部分病人血清IgA增高，尤其是血清IgA纖維連接蛋白聚合物（IgA-FN）增高更有意義。可有肌酐清除率降低，血尿素氮和血肌酐增高。根據臨床可初步診斷IgA腎病（炎），確診必須做腎組織免疫病理檢查。

4. Differential diagnosis

Should be differentiated from lupus nephritis, purpura nephritis, and occult nephritis. Severe cases may be difficult to distinguish from chronic glomerulonephritis.

bubble_chart Treatment Measures

1. General Treatment

Prevent common cold and excessive fatigue, and use nephrotoxic drugs with caution. Antibiotic therapy should be administered in case of infection. For those with recurrent chronic tonsillitis, tonsillectomy may be performed.

(1) For patients with significant hematuria, oral administration of Root Leaf or Flower of Common Threewingnut glycosides, dipyridamole, ACEI, and high-dose vitamin C may be used.

(2) For those presenting with nephrotic syndrome, refer to the nephrotic syndrome section for treatment.

(3) For cases with manifestations similar to chronic glomerulonephritis, manage according to chronic glomerulonephritis protocols.

(4) For cases where pathological examination shows predominant crescent formation with IgA deposition, intensive plasma exchange therapy and drug treatment may be employed (refer to the treatment of rapidly progressive glomerulonephritis).

3. Blood Purification Therapy

Patients with acute renal failure or those who have developed chronic renal failure require hemodialysis or peritoneal dialysis.