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

Kidney biopsy should be considered in patients with persistent proteinuria (> 1 g/d) because the diagnostic and prognostic information will guide the choice of therapy.

Imaging studies are rarely performed in such patients and are done in patients with persistent proteinuria if glomerular disease is being considered to review the size and echogenicity of the kidneys that might signify chronicity of the disease.

Light microscopy and immunofluorescence of the biopsy specimen are performed by a renal pathologist to identify specific histologic characteristics of disease and to show the degree of glomerular injury.

Immunofluorescence findings are the pathologic hallmark of IgA nephropathy.

Renal biopsy is performed and shows patches of interstitial fibrosis with tubular atrophy, which indicates chronic irreversible damage to the renal parenchyma. Immunofluorescence microscopy shows IgA deposition and diffuse glomerular lesions.


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