Nejm 1998;339:895

Cause:Sequel of membranous and proliferative glomerulonephritis (GN) and idiopathic

Pathophys: Gradual progression of initiating disease leads to glomerular hyalinization with secondary tubular atrophy, and interstitial fibrosis leads to renal failure

IgA deposits are presumed immune complexes

50% probably membranous GN, 20% probably proliferative GN, 30% unknown etiology including IgA nephropathy, 10% of all end-stage renal disease, higher in older men

Sx:Nephrotic syndrome (Nephrotic Syndrome)

Si:of nephrosis, HT

Slowly decreasing renal function over many years, usually >20 yr

of renal failure (Chronic Kidney Disease)

Lab:

Chem:BUN and creatinine elevated

Path:Renal biopsy shows scarring, focally or diffuse

Urine:Proteinuria

Rx:

Supportive (Chronic Kidney Disease) including aggressive ACE inhibitor rx of HT

of IgA nephropathy: fish oil, 12 gm qd may slow progression by preventing damage by mediators like protaglandins, etc