June 24, 2022

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IgA nephropathy is more likely to progress to uremia?

IgA or membranous nephropathy: Which nephropathy is more likely to progress to uremia?

 

IgA nephropathy is more likely to progress to uremia?  Whether IgA nephropathy or membranous nephropathy, they all may progress to uremia.

IgA nephropathy (IgAN) and membranous nephropathy (MN) mentioned here respectively refer to primary IgA nephropathy and idiopathic membranous nephropathy, that is, IgA nephropathy or membranous nephropathy that is not caused by other diseases.

IgA nephropathy and membranous nephropathy are also very common pathological types in primary glomerulonephritis. Together, they account for approximately 60-70% of primary glomerulonephritis.

Clinically, IgA nephropathy and membranous nephropathy can be manifested as nephritis syndrome, that is, the patient’s 24-hour urine protein quantitative does not exceed 3.5 grams (a few patients can also exceed 3.5 grams); IgA nephropathy and membranous nephropathy can also be manifested as nephropathy Syndrome, that is, the patient’s 24-hour urine protein quantification exceeds 3.5 grams and plasma albumin is as low as 30 g/L.

Among them, nephritis syndrome is more common in IgA nephropathy, nephrotic syndrome is more common in membranous nephropathy, and they all belong to the category of chronic kidney disease (CKD).

IgA nephropathy and membranous nephropathy, although both are the names of pathological diagnoses, they can be diagnosed or suspected without renal puncture. Among them, IgA nephropathy can be collected through medical history, especially nephropathy with gross hematuria within 72 hours after a cold or upper respiratory tract sensation, and combined with blood draw to detect the IgA/C3 ratio.

After comprehensive analysis, the diagnosis or suspected kidney disease can be obtained. diagnosis. Among them, membranous nephropathy can be the result of the appearance of lower limbs without an inducement, or even systemic edema or accompanied by reduced urine output, and the results of anti-M-type phospholipase A2 receptor antibody (anti-PLA2R antibody) detected by blood sampling. The diagnosis of this kidney disease can also be made.


Of course, it is not enough to make the diagnosis of IgA nephropathy or membranous nephropathy. It is necessary to comprehensively analyze and comprehensively evaluate the patient’s condition based on the patient’s medical history, symptoms, signs, related examination data, and previous medications. In particular, it is necessary to clarify their renal function status (the degree of decline in glomerular filtration rate), immune function, urine protein level, comorbidities, complications, and the patient’s degree of importance and management of their own kidney disease. Because these factors are closely related to whether the patient is prone to develop chronic renal failure and uremia.


As mentioned above, IgA nephropathy and membranous nephropathy, which type of kidney disease is more likely to progress to uremia or which type of kidney disease is not easy to progress to uremia? This requires one-by-one analysis from the following five aspects.

 

 

1. Before treatment, those who have only a small amount of proteinuria or only simple hematuria are not easy to progress to uremia

Both IgA nephropathy and membranous nephropathy can be manifested as nephritis syndrome. Some patients have only a small amount of proteinuria or only simple hematuria, and no hypertension. After general treatment (such as the addition of sartan or pristine drugs) , You can also check regularly, avoid using or cautiously using nephrotoxic drugs, and actively prevent and treat infections. It is not easy for patients to develop uremia.

 


2. After treatment, poor control of urine protein and/or blood pressure is likely to progress to uremia

Whether it is IgA nephropathy or membranous nephropathy, as long as the patient’s urine protein and/or blood pressure is high or high, further treatments are required, such as RAS blockers (sartan or pristine drugs), glucocorticoids, Immunosuppressants and other related drugs can be selected and used according to the condition. After the above active treatment, if the patient’s urine protein and/or blood pressure are still poorly controlled, it is easy to progress to uremia.

 


3. IgA nephropathy is grade 1-3, it is not easy to progress to uremia

According to the degree of pathological damage, IgA nephropathy is generally divided into five grades. Among them, patients with IgA nephropathy Lee 1-3 are relatively mild, and patients are not prone to progress to uremia. Among them, IgA nephropathy Lee 4-5 is relatively severe and patients are more likely Progressed to uremia. In particular, the glomerular lesions present with severe diffuse mesangial hyperplasia and sclerosis, or accompanied by crescent changes, and renal tubular atrophy, etc., are more likely to progress to uremia.

 


4. Membranous nephropathy that can always get complete remission, not easy to progress to uremia

Most membranous nephropathy is clinically manifested as nephrotic syndrome, that is, the patient’s 24-hour urine protein quantitative exceeds 3.5 grams, and the plasma albumin drops to 30g/L, and the patient will also have acute kidney injury and thrombosis. Complications such as embolism. Even if it looks very serious, after active treatment, as long as complete remission can be achieved, and the 24-hour urine protein quantitative control is below 0.3-0.5 grams, patients with membranous nephropathy are not easy to progress to uremia.


5. If the glomerular filtration rate has dropped below 45ml/min, it is easy to progress to uremia
Regardless of whether the urinary protein of patients with IgA nephropathy or membranous nephropathy is high or not high, and those with a long medical history, if their glomerular filtration rate has gradually dropped below 45ml/min, and there is no acute kidney injury Related aggravating factors indicate that after the patient’s condition has progressed to stage 3b of chronic kidney disease, that is, after the diagnosis of chronic renal insufficiency, his condition will continue to progress, and the rate of further progress will accelerate, and the patient is more likely to progress to uremia disease.

 


In summary, whether IgA nephropathy or membranous nephropathy, they may all progress to uremia. But in general, as long as they are treated actively and standardized, most of their patients will not progress to uremia, that is, only a few patients with IgA nephropathy and membranous nephropathy will eventually progress to uremia. Therefore, patients who have been diagnosed with IgA nephropathy or membranous nephropathy do not need to worry too much.

 

 

(source:internet, reference only)


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