IgA nephropathy (also known as IgA nephritis, IgAN, Berger's disease and synpharyngitic glomerulonephritis) is a form of glomerulonephritis (inflammation of the glomeruli of the kidney). This should not be confused with Buerger's disease, an unrelated condition.
IgA nephropathy is the most common glomerulonephritis throughout the world [1] Primary IgA nephropathy is characterized by deposition of the IgA antibody in the glomerulus. There are other diseases associated with glomerular IgA deposits, the most common being Henoch-Schönlein purpura (HSP), which is considered by many to be a systemic form of IgA nephropathy. HSP presents with a characteristic purpuric skin rash, arthritis, and abdominal pain and occurs more commonly in young adults (16-35 yrs old). HSP is associated with a more benign prognosis than IgA nephropathy. In IgA nephropathy there is a slow progression to chronic renal failure in 25-30% of cases during a period of 20 years.
But what are the Prognosis of IgA Nephropathy?
IgA Nephropathy is a rapidly progressive disease, so we should pay much attention to it. We have studied the mechanism of its progression with the most advance theory of renal fibrosis so as to interfere in the therapeutic measures. Clinical indexes of delaying and reversing the prognosis of IgA Nephropathy include proteinuria, level of hematuria, Hpertension and level of creatinine. Therefore we try to adopt a method combining TCM (Traditional Chinese Medicine) with western medicine to reduce these indexes to an ideal level.
Pathological indexes that influence the prognosis are also important. Pathological changes of IgA Nephropathy involve the glomeruli, renal rubules, renal interstitium and renal blood vessel and show great variety in degree and complexity. Pathological changes by renal biopsy are related to the clinical manifestations of the time and they are dynamic and developing with time. Reversibility and irreversibility are relatively spoken.
The following three aspects have certain influence on prognosis of IgA Nephropathy.
1. Pathological changes of the glomeruli: global sclerosis of the glomeruli is a recognized index of a poor prognosis. Proliferation of mesangial cells and matrix as well as deposition of IgA in mesangial area can remit and disappear after treatment, so they don’t have much influence on long-term prognosis. While periodic glomerulosclerosis, glomeruli-capsule adhesion, crescent formation and deposition of immune complex along the capillary loop are all indexes of a poor prognosis but it is without certainty on the basis of a multiplicity. It reminds us that the above changes are still reversible and should be treated positively instead of giving up.
2. Pathological changes of the tubule-interstitium: interstitial fibrosis and tubular atrophy are the index of a poor diagnosis, while infiltration of the interstitial inflammatory cells can be reduced or disappear after positive treatment and doesn’t have much influence on the prognosis.
3. Pathological changes of the tubules: with aggravating of the changes, reduction of blood capillary around the tubules also has direct influence on the prognosis.
