IgA nephritis should do what?

1 urine test
(1) hematuria: about 40% to 45% of patients in the clinical performance of the naked eye or microscopic hematuria, from 35% to 40% of the patients showed simple microscopic hematuria or microscopic hematuria with a small amount of proteinuria. The sustainable gross hematuria few hours to a few days after to persistent microscopic hematuria, some patients with hematuria disappeared, but often seizures, reproduce gross hematuria attack.
(2) proteinuria: mild proteinuria, general urinary protein excretion <1g/24h, a small number of patients with massive proteinuria or even nephrotic syndrome.
2 immunological tests
(1) IgA increased: from about 1/4 to L / 2 of the patients serum IgA increased mainly multimeric IgA increased.
(2) circulating immune complexes: IgA circulating immune complexes and (or) IgG circulating immune complexes can be detected in the blood of about 1/5 to 2/3 of the children.
(3) anti-"O" elevated titer of anti-"O": A small number of patients.
(4) complement: C3, C4 and more normal.
3 renal biopsy: renal biopsy diagnosis of IgA nephropathy, the renal pathology light mirror change performance for mesangial degree from focal segmental proliferation to diffuse mesangial proliferative ranging. Part mesangial proliferative heavier visible The mesangial insert to form segmental two-track. Sometimes see segmental glomerulosclerosis, capillary collapse, balloon adhesions. Individual lesions severe hyaline change, global sclerosis, individual capillary tube loop necrosis and crescent formation. The Masson staining mesangial area a large number of addicted to the the fuchsin sediment renal immunopathological visible the mesangium significant IgA deposition. Electron microscope for varying degrees of mesangial cells and stromal hyperplasia, electron-dense material by mesangial area, Vice mesangial area extended to the endothelial cells of the capillary wall or on subcutaneous.

The IgA nephritis Western medicine treatment

(A) treatment
Past that the disease is no specific therapy, and relatively good prognosis and treatment measures are not very positive. But in recent years, along with in-depth understanding of the disease, many studies have shown that aggressive treatment can significantly improve the prognosis. IgA nephropathy from pathological changes to the clinical manifestations are very different, very different prognosis, therefore, must be done individualized treatment measures.
A general principle: control the infection, such as repeated episodes of oropharyngeal and upper respiratory tract infection helps reduce gross hematuria, tonsillectomy reduce the onset of gross hematuria remains controversial. Should actively control blood pressure of hypertension in patients with IgA nephropathy urine protein less than 1g/24 hours, target blood pressure control 130/80mmHg following the urine protein than 1g/24 hours, should be the target blood pressure control in 125/75mmHg less.
Adrenal corticosteroids and immunosuppressants onset nephrotic syndrome or rapidly progressive nephritic syndrome in children, and should be of corticosteroids and immunosuppressive therapy. Japan has conducted a nationwide multi-center controlled study, the use of prednisone and immunosuppressive treatment of IgA nephropathy in children, the proportion of its long-term renal insufficiency was significantly lower than the general treatment of children.
Kabayashi had retrospective study of two groups of patients, a group of 29 patients, proteinuria> 2g / d prednisone 1 to 3 years, 2 to 4 years of follow-up, early results show that hormone therapy (Ccr above 70ml/min time) is beneficial for stable kidney function and slow disease progression. Another group of 18 cases of proteinuria ~~ 2g / d of IgA nephropathy corticosteroid therapy, Dipyridamole (dipyridamole) and indomethacin (Indocin) and 42 cases of IgA patients as a control treatment group in stable renal buck and reduce proteinuria aspects, significantly better than the control group.
Lai et al reported a prospective randomized controlled trial, 17 patients daily doses of prednisone 4 months. 38 months compared with 17 cases in the control group, the average observed two groups of endogenous creatinine clearance was no significant difference, prednisone nephrotic syndrome patients with minor lesions, can significantly improve the response rate, but there are some adverse reactions. This research suggests that prednisone IgA nephropathy.
It was reported that a group of adult IgA nephropathy control study to examine the efficacy of azathioprine and prednisone. 66 patients azathioprine and prednisone, the results show that slow down the progress of IgA nephropathy is useful to compare with the control group of 48 patients who did not receive the treatment.
Recently, Nagaoka et al reported a novel immunosuppressant - mizoribine (mizoribine) for the treatment of children with IgA nephropathy, drug safety, easily tolerated, can be long-term use and can significantly reduce the degree of proteinuria and hematuria, repeated kidney in vivo Histological examination confirmed alleviate the severity of kidney tissue.
Cyclosporine reported less, Lai cyclosporine conducted a randomized, single-blind controlled trial, the treatment group and the control group, 12 cases of patients with proteinuria greater than 1.5 g / d, and creatinine clearance The rate of decline Ccr (77 ± 6) ml / min, to cyclosporine 12 weeks of treatment, the plasma concentration level of control at 50 to 100ng/ml. The results show a significant reduction in protein excretion, accompanied by increased plasma creatinine clearance rate, but these changes disappear after the termination of treatment.
In short, the efficacy of immunosuppressive agents in the treatment of IgA nephropathy has yet to be evaluated. The Woo and Wallker observed the effect of combination therapy of cyclophosphamide, warfarin, dipyridamole (dipyridamole) and hormone results compared with the control group, during treatment can reduce proteinuria and stabilize renal function, but the follow-up of 2 to 5 years after renal protection with the control group compared with no significant difference.
Immunoglobulin in an open prospective study, Postoker and others with high dose gamma globulin intravenous, 1 / d, each 2g/kg, qd for 3 months, then changed to 16.5% human serum gamma globulin intramuscular injection, each 0.35ml/kg, every half times, once every six months and found that, after treatment, urinary protein excretion decreased from 5.2g / d to 2.2g / d, hematuria, and white blood cells in urine disappear, the glomerular filtration rate reduced monthly rate by 3.78ml/min slow down to 0.
Fish oil (fish oil) IgA nephropathy patients lack of essential fatty acids, fish oil supplement essential fatty acids, thus preventing early glomerular damage. Fish oil rich in long-chain omega-3-polyunsaturated fatty acids, EPA (Eicosapentaenoic acid), DHA, these substances can be used instead of arachidonic acid, and play a role as a substrate for lipoxygenase and cyclooxygenase, changes in membrane liquidity, reduce platelet aggregation. Collected 20 cases of patients with IgA nephropathy in 1984 Hamazaki done a preliminary study, the treatment group receiving fish oil treatment, renal function remained stable, the control group did not receive fish oil, lower plasma creatinine clearance.
Donadio conducted a multi-center, double-blind, randomized controlled trial in 1994. A total of 55 patients were collected daily oral 12g of fish oil for the treatment group, 51 patients served olive oil for the control group, 68% of the basis of serum creatinine values ​​increased in selected cases, the initial primary endpoint was serum creatinine increase> 50% result is to observe the end of the treatment period (2 years), the fish oil group, only 6% of patients progress, up to 33% in the control group, for 0.03mg/dl annually serum creatinine increased rate in the treatment group, the control group was 0.14mg / dl. The ESRD incidence after four years, the control group was 40%, compared with 10% in the treatment group, the results are statistically significant, no patients discontinued therapy due to adverse events. That fish oil can slow the rate of decline in GFR. In 1999, the author has reported the results of the long-term follow-up of cases, that early and continued use of fish oil can significantly slow down the high-risk patients with IgA nephropathy, renal failure times.
5 Copp recently organized a six-year prospective multi-center double-blind randomized controlled study to investigate the long-term taking shellfish that benazepril, Plymouth [0.2mg / (kg · d)] of moderate proteinuria, renal children and young patients with IgA nephropathy better therapeutic efficacy, and the test is completed in 2004.
In the past been used phenytoin 5mg / (kg · d) treatment of IgA nephropathy found to decrease the level of serum IgA and polymeric IgA, and hematuria decrease in the number of attacks, but not reduce circulating immune complexes, and the long-term effect is not certainly, in recent years, has been rarely used.
Chinese medicine treatment of IgA nephropathy also have a certain effect, moderate proteinuria, use Tripterygium the lmg / (kg · d) treatment for 3 months, will receive significant effects.
6. Dialysis and renal transplantation feasible dialysis and transplantation in the treatment of patients with end-stage renal failure.
(B) The prognosis
Adult IgA nephropathy after 10 years, about 15% progress to the terminal renal failure, increased to 25% to 30% after 20 years. The prognosis of IgA nephropathy in children better than adults, Yoshikawa reported that after 20 years, 10% progressed to terminal renal failure. Many prognostic factors, severe proteinuria, hypertension, severe glomerulosclerosis and interstitial tubule lesions are indicators of poor prognosis; men also easy to progress; the gross hematuria prognosis still controversial. According to reports, IgA nephropathy patients from renal normal since annual GFR reduction rate of 1 ~ 3ml/min the performance nephrotic syndrome patients with IgA nephropathy GFR decreasing rate 9ml/min. With hypertension, GFR reduce speed to up to a year 12ml/min Therefore, control of blood pressure and proteinuria is essential in the treatment of IgA nephropathy.

Therapeutic treatment of different types of IgA nephropathy

In the theory of Chinese medicine, not only medical treatment with drugs, you can also rely on diet to ease the symptoms. Today to introduce the therapeutic treatment of different types of IgA nephropathy details see below:
, Spleen and kidney yin chronic IgA nephropathy PERSISTING
Symptoms: visible microscopic hematuria with proteinuria, fatigue, weakness, waist and knee pain, cold or dysphoria heat, spontaneous sweating or night sweats, thirst or throat pain, pink tongue with scalloped edges or fat tongue thin white or thin yellow and dry, rapid pulse and weakness.
Diet: should the double kidney Yin Spleen, hemostatic rule is, heterophylla, Astragalus, habitat, yam, Alisma the 15g, the thistle 30g, Poria 20g, cornus, paeonol the 10g, notoginseng powder 1g , rice 100g, sugar amount. The first nine flavor cook the juice into the rice congee join notoginseng powder, sugar and absorbed, can be boiled again.
(2), liver-kidney chronic IgA nephropathy PERSISTING
Symptoms: visible and pain associated with microscopic hematuria or proteinuria, five upset hot, dry throat, leader of dizziness, tinnitus, low back pain, dry stool, red tongue Taigan rapid pulse string breakdown.
Diet: should be used to nourish the liver and kidney, bleeding and other rule is, Poria, thistle, 30g, habitat, yams, Silver Flower 20g, Rhizoma Imperatae, Alisma 15g, Anemarrhena, Cork 12g, cornus fried Gardenia child each 10g, blood glutinous rice 100g, honey to taste. 11 taste cook the juice into the blood glutinous rice congee, seasoning and honey. 1 day, 2 doses.
, Firelight the flaming type acute exacerbation period IgA nephropathy
Symptoms: mind Fanre, mouth sores, urine the redness or microscopic hematuria, red tongue, thin yellow coating, rapid pulse.
Diet: should adopt the pure heart Chufan, cooling blood to stop bleeding and other rule is, thistle 30g, habitat 20g, the Rhizoma Imperatae 15g, bamboo leaves 12g fried gardenia Health hay 10g, rice 100g sugar amount. The first six flavor cook the juice into the thin rice boiled thick porridge, can add sugar to taste. 1 day, 2 doses.
Bladder damp-heat in acute exacerbation of IgA nephropathy
Symptoms: visible urinary frequency, urgency, urinary fever, urinary astringent, painful urination, low back pain, dry stool, urine redness or microscopic hematuria, red tongue, yellow coating, rapid pulse.
Diet: should adopt clearing heat, cooling blood to stop bleeding and other rule is the thistle, talc (cloth) 30g, habitat 20g, fried Puhuang, Oujie charcoal, fried Gardenia 10g, bamboo leaves 12g, angelica, licorice of 6g, through the grass 3g, red bean, rice 60g, sugar amount. Top 10 flavor cook the juice into the red bean, rice congee can add sugar to taste. 1 day, 2 doses.

Common symptom of IgA nephropathy

Learn the common symptoms of IgA nephropathy has great significance for the timely detection and treatment of IgA nephropathy. The general symptoms of IgA nephropathy is relatively diverse, but can generally be divided into asymptomatic with two obvious symptoms.
Common symptom of IgA nephropathy, we have the following from both analysis, respectively.
A patient is often asymptomatic urinary abnormalities, only found in the examination of microscopic hematuria and mild proteinuria, occasional tube. The small number of patients may manifest as nephrotic syndrome, severe hypertension and chronic renal failure. This makes the increased occult disease, is not easy to detect, which often lead to IgA nephropathy incidence of occult exacerbations, is not conducive to late treatment.
Another common in patients with obvious symptoms. As a result of respiratory infections or gastrointestinal tract, urinary tract infection 1-2 days gross hematuria last a few hours or a few days later to become microscopic hematuria after varying degrees of proteinuria or microscopic hematuria. A small number of patients may have a transient high blood pressure and increased blood urea nitrogen, and individual patients or even acute oliguric renal failure syndrome, but can ease after symptomatic treatment and rest.Gross hematuria disappeared, about 60% of patients will relapse after respiratory tract infection, hematuria again.

Clinical diagnosis and identification of IgA nephropathy?

How clinical diagnosis and identification of IgA nephropathy? IgA nephropathy is a unique glomerular nephropathy, IgA nephropathy, other nephropathy, confirmed IgA nephropathy must have a pathological examination of renal biopsy immune.
Of course, at the time of diagnosis is more common diagnosis, such as young men or microscopic hematuria and (or) asymptomatic proteinuria in patients with occurrence of pharyngitis synchronization hematuria, should be considered from the clinical IgA nephropathy may however still You must do the renal biopsy diagnosis.
How clinical diagnosis and identification of IgA nephropathy? IgA nephropathy diagnosis is often confused with some other kidney, then they need to IgA nephropathy and some other kidney differentiated. Mainly to identify with the following diseases:
Allergic purpura nephritis: Patients may present with microscopic hematuria or gross hematuria. Renal biopsy may have the same broad primary IgA nephropathy the mesangial area IgA deposition. However, the HSPN patients often typical skin purpura, abdominal pain, joint pain performance.
Thin basement membrane nephropathy: thin basement membrane nephropathy main clinical manifestations of recurrent hematuria, urine Pf4 level can help with IgA nephropathy identify. Must depend on renal biopsy electron microscopy to check the with IgA nephropathy identification.
3. Streptococcal infection acute glomerulonephritis: IgA nephropathy is also likely to occur in young males in upper respiratory tract infections (acute tonsillitis) hematuria may have proteinuria, edema and hypertension, or renal damage .
4 non - IgA mesangial proliferative glomerulonephritis: non-IgA mesangial proliferative glomerulonephritis with IgA nephropathy is difficult in clinical identification. To rely on the renal biopsy immune pathological examination to identify.

Concern about iga nephropathy prognosis factors

IgA nephropathy is the most common primary glomerulonephritis, but its pathogenesis is not clear, the general prognosis. According to statistics, there are about 3 percent iga nephropathy patients eventual development of the disease to end-stage renal disease. Factors also concern about iga nephropathy prognosis is particularly necessary.
Iga nephropathy treatment with the treatment of the continuous advancement of technology has also been considerable development. The new study suggests that further treatment will be aimed at preventing the inflammatory damage caused by mesangial IgA deposition and reduce by the infiltration of neutrophils and their release cytokines delay kidney deterioration. Iga nephropathy prognosis of some of the factors associated with concern about iga nephropathy prognosis factors, these factors iga nephropathy prognosis more.
Concern about iga nephropathy prognosis factors, and prognostic factors:
Persistent microscopic hematuria associated with proteinuria, the prognosis is poor.
2.IgA nephropathy in patients with hypertension, especially difficult to control severe haypertension and poor prognosis.
3. Pregnancy patients with IgA nephropathy, IgA nephropathy in patients with hypertension and renal dysfunction, pregnancy is generally safe.
4 male patients, the greater age of onset and poor prognosis.
5.IgA nephropathy showed patients with nephrotic syndrome, if mild renal pathological changes, the the good reaction glucocorticoid treatment, the prognosis is good.
6, severe proteinuria often prompted the eventual development of renal insufficiency, the prognosis is poor.