HDCN-MGR: Hematuria and flank pain in a young woman (continued)

Answer to Review Questions

1. Which of the following factors predicts an adverse outcome in patients with IgA nephropathy?

a. Greater than 10 red blood cells per high power field on U/A
b. Repeated episodes of gross hematuria
c. Interstitial fibrosis by renal biopsy
d. All of the above indicate a poor prognosis

Interstitial fibrosis on renal biopsy is a significant predictor of a poorer renal prognosis.

There is no evidence that the degree of hematuria predicts a worse outcome in IgAN. Patients with gross hematuria actually seem to have a better prognosis than patients with persistent microscopic hematuria. Why this is so is unknown, and seems counterintuitive. It is posible that chronic microscopic hematuria serves as a marker of persistent inflammation in the kidneys leading to progressive scarring. Patients with intermittent gross hematuria may not have the same chronic, persistent exposure to inflammation.


2. A feature which would favor a diagnosis of lupus nephritis instead of IgA nephropathy on renal biopsy is:

a. C1q deposition
b. Predominant IgA deposition
c. The presence of both IgA and IgG
d. A mesangial localization of immune deposits

The presence of substantial C1q deposits is a helpful clue to the pathologic diagnosis of lupus nephritis instead of IgA nephropathy.

Predominant IgA deposition is typical of IgA nephropathy.
IgA and IgG are seen together in both diseases.
A mesangial localization can be seen in either disease.



3. A disease NOT associated with IgA nephropathy is:

a. Dermatitis herpetiformis
b. Leptospirosis
c. Membranous nephropathy
d. HIV infection

There is no known association of leptospirosis with IgA nephropathy.

Dermatitis herpetiformis, membranous nephropathy and HIV infection have all been associated with IgA.
In HIV infection IgA antibodies directed against anti-HIV IgG have been demonstrated in the kidney (Kimmel et al N Engl J Med 327:702, 1992). Nonetheless, less than 10% of HIV infected patients have been found to have IgA deposits in the glomerulus. The significance of the deposits is unclear since few patients develop hematuria.


4. A treatment recently reported to be effective in IgA nephropathy is:

a. Pulse methylprednisolone
b. Alternating courses of steroids and chlorambucil
c. Calcium channel blockers
d. Fish oils

Donadio's study of fish oils demonstrates marked clinical efficacy at a dose of 12 grams a day.

There is no proven efficacy for pulse methylprednisolone in routine cases of IgAN.
A typical regimen for membranous nephropathy, but no reports of its use in IgAN.
Calcium channel blockers are not known to effectively treat IgAN.


Additional information about IgA on HDCN



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