Wednesday, 8 September 2010

MRCP revision battle 5.3: IgA Glomerulonephritis

As if the glomerulonephropathies aren't tricky enough (hence why series 5 of the battles only discusses one of them) they can also have a series of pseudonyms/ 'nicknames.'  For example, IgA nephropathy also goes by the labels 'Bergers disease' and 'mesangioproliferative glomerulonephritis'.  For simplicity, I'll just refer to it as IgA nephropathy.

IgA nephropathy is the commonest GN in adults, and it classically affects young males after an URTI.  So, in the exam look out for the 25 yr old man who has haematuria following a sore throat.

Symptoms may just be micro/macro haematuria, or match the nephrotic syndrome triad.

Incidence is increased in those from the far east, and those with HLA DQw7 or HLA B35.

Associations include cirrhosis, dermatitis herpetiformis, ank spon, Wiskott-Aldrich syndrome and chronic liver or lung disease.

IgA is positive in 50% of cases and C3 tends to be raised.

25% of cases progress to end stage renal disease.

Frank haematuria is associated with a good prognosis.
Being male, having proteinuria, hypertension, smoking or high lipids are all associated with a poor prognosis.

Phew, thats one of the GN covered... a few more to face at a later date... now lets diversify for the last battle of the day to acute epiglottis.