Skill Checkup: A 56-Year-Old Man With Primary IgA Nephropathy and Fatigue, Abdominal Pain, and Frothy Urine

A. Brent Alper, Jr, MD, MPH


May 01, 2023

IgA vasculitis is a systemic, acute, IgA-mediated disease that is characterized by generalized vasculitis in the gastrointestinal tract, kidneys, joints, and, sometimes, lungs and central nervous system. It has been closely linked to IgA nephropathy.

Membranoproliferative glomerulonephritis (MPGN) is an uncommon cause of chronic nephritis that occurs primarily in children and young adults. The three characteristic histopathologic findings in MPGN that show a pattern of glomerular injury are: proliferation of mesangial and endothelial cells and expansion of the mesangial matrix; the thickening of the peripheral capillary walls by subendothelial immune deposits and/or intramembranous dense deposits; and mesangial interposition into the capillary wall, giving rise to a double-contour or tram-track appearance on light microscopy.

IgA dominant postinfectious glomerulonephritis occurs when an immunologic mechanism triggers inflammation and proliferation of glomerular tissue and is associated with chronic infections. It generally manifests with the sudden onset of hematuria, proteinuria, and red blood cell casts in the urine and is often accompanied by hypertension, edema, azotemia, and renal salt and water retention.

Lupus nephritis is clinically evident in over half of patients with systemic lupus erythematosus and histologically evident in most patients with lupus, even those who don't exhibit overt kidney disease. Patients who are asymptomatic may exhibit hematuria or proteinuria, whereas patients with active nephritis may present with nausea/vomiting, headache, dizziness, and peripheral edema.


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