How to determine the stages of IgA nephropathy?

Written by Ji Kang
Nephrology
Updated on January 16, 2025
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IGA nephropathy has different grading methods, such as Lee grading and Hass grading. Both classify the pathological changes of IGA nephropathy into five stages, with similar descriptions. According to the Lee grading: Grade 1: Most glomeruli are normal, with occasional mild mesangial widening or without cellular proliferation, and no tubulointerstitial changes. Grade 2: Glomeruli show focal mesangial proliferation, with no tubulointerstitial changes. Grade 3: Glomeruli exhibit diffuse mesangial proliferation, with occasional segmental focal lesions, rare crescents, and adhesions, focal interstitial edema, and rare cellular infiltration. Grade 4: Glomeruli show diffuse severe mesangial proliferation and sclerosis, partial or segmental glomerulosclerosis, crescent formation observed but less than 45%, tubular atrophy, interstitial infiltration. Grade 5: The nature of the lesions is similar to grade 4 but more severe. Crescent formation in glomeruli is greater than 45%.

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Written by Zhou Qi
Nephrology
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Why doesn't IgA nephropathy cause swelling?

IgA nephropathy refers to the abnormal deposition of IgA immunoglobulin in the glomeruli of patients, which causes an inflammatory response and damages the glomerular capillaries. The extent of this damage varies, so not all patients will experience swelling. If the condition is severe, causing significant proteinuria, patients may develop hypoproteinemia and consequent decrease in plasma colloidal osmotic pressure, leading to swelling. If renal failure has occurred, the kidneys' ability to excrete water decreases, which can also cause swelling. Some patients may experience swelling due to damage to the renal tubules, which increases the reabsorption capacity for water. Otherwise, patients may not show obvious swelling, such as those with only mild proteinuria and hematuria, whose clinical symptoms are not pronounced.

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Written by Hu Lin
Nephrology
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IgA kidney disease's etiology

IgA nephropathy can be divided into primary and secondary IgA nephropathy. Secondary IgA nephropathy includes, for example, lupus nephritis, allergic purpura nephritis, liver disease-related kidney damage, rheumatoid arthritis kidney damage, and so on. The etiology of primary IgA nephropathy is mainly due to the deposition of a type of immunoglobulin, IgA, in the mesangial area of the glomeruli, leading to a series of immune responses, which in turn cause inflammatory damage, resulting in a chronic glomerulonephritis. This form of IgA nephropathy is mainly related to mucosal immune defense, meaning it is linked to certain infectious factors. Additionally, some patients have high reactivity of their mucosa to certain food antigens, which leads to a series of immune-mediated inflammatory responses.

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Written by Zhou Qi
Nephrology
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How is IgA nephropathy diagnosed?

The diagnosis of IgA nephropathy relies on pathological examination. The name "IgA nephropathy" itself is a term used in immunopathological diagnosis, describing a type of chronic glomerulonephritis. There are many reasons that can cause inflammatory reactions in the kidneys, and the underlying mechanisms of the disease vary. Specifically, IgA nephropathy refers to the abnormal deposition of IgA immune complexes in the mesangial areas of the glomeruli. Therefore, a pathological examination is necessary for diagnosis. Typically, under a light microscope, proliferation of mesangial cells and widening of the mesangial areas can be observed. Additionally, immunofluorescence testing is conducted to detect a large presence of IgA immune complexes in the glomerular mesangial areas, confirming the diagnosis of IgA nephropathy.

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Written by Zhou Qi
Nephrology
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The characteristics of proteinuria in IgA nephropathy

IgA nephropathy is a pathological type of chronic glomerulonephritis, which can cause patients to exhibit symptoms such as proteinuria and hematuria. Regarding the characteristics of proteinuria, it is generally primarily glomerular proteinuria. In the classification of patients' proteinuria, glomerular proteinuria accounts for a large proportion. If IgA nephropathy presents as chronic nephritis or nephrotic syndrome, the patient's level of proteinuria will be quite severe, with significant amounts of proteinuria, where the 24-hour urinary protein quantification may exceed 1g or even reach more than 3.5g. However, not all patients with IgA nephropathy have such high levels of proteinuria; some may only have mild proteinuria.

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Written by Zhou Qi
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Is IgA nephropathy sexually transmitted?

IgA nephropathy, a type of chronic glomerulonephritis, does not transmit through sexual intercourse. This condition involves a sterile inflammatory response within the glomeruli of the kidneys, not caused by pathogens such as bacteria, viruses, or fungi. Instead, it results from an immune dysfunction, causing inflammation in the glomeruli without any infectious agents. Therefore, IgA nephropathy is not contagious, and sexual intercourse does not pose a risk of transmitting the condition to a sexual partner. As such, patients with IgA nephropathy can engage in sexual activities if their physical condition permits.