Skip to main content
SpringerLink
Log in

IgA nephropathy and Henoch-Schönlein purpura

  • Chapter
The Treatment of Glomerulonephritis

Part of the book series: Developments in Nephrology ((DINE,volume 40))

  • 148 Accesses

Abstract

IgA nephropathy (IgAN) is a common pattern of glomerulonephritis defined by mesangial IgA deposition. It may occur at any age but most commonly presents in the second and third decades of life. Recurrent macroscopic haematuria is the most frequent clinical presentation but other patients present with microscopic haematuria, proteinuria or progressive renal failure. The apparent prevalence of the disease will increase if urine screening is widely used in any population in which renal biopsy is recommended for those with minor urine abnormalities. Hypertension is particularly common and usually predates renal impairment. Rapidly progressive renal failure is unusual; it may result from acute tubular necrosis as a consequence of macroscopic haematuria, or from superimposed crescentic nephritis. Recurrent IgA deposition after transplantation is common. IgA deposits are found in 50% of transplants, although structural glomerular injury is uncommon and the overall success of transplantation is not diminished.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bailey RR, Lynn KL, Robson RA, Smith AH, Wells JE. Long term follow up of patients with IgA nephropathy. N Z Med J 1994;107:142–4.

    PubMed  CAS  Google Scholar 

  2. Ibels LS, Gyorgy AZ. IgA nephropathy: analysis of the natural history, important factors in the progression of renal disease, and a review of the literature. Medicine (Baltimore) 1994;73:79–102.

    CAS  Google Scholar 

  3. Feehally J. Immune mechanisms in glomerular IgA deposition. Nephrol Dial Transplant 1988;3:361–78.

    PubMed  CAS  Google Scholar 

  4. van Es LA, de Fijter JW, Daha MR. Pathogenesis of IgA nephropathy. Nephrology 1997;3:3–12.

    Article  Google Scholar 

  5. Galla JH. IgA nephropathy. Kidney Int 1995;47:377.

    Article  PubMed  CAS  Google Scholar 

  6. Allen AC. Abnormal glycosylation of IgA: is it related to the pathogenesis of IgA nephropathy? Nephrol Dial Transplant 1995;10:1121–4.

    PubMed  CAS  Google Scholar 

  7. Coppo R, Roccatello D, Amore A et al. Effects of a gluten-free diet on primary IgA nephropathy. Clin Nephrol 1990;33:72–86.

    PubMed  CAS  Google Scholar 

  8. Ferri C, Puccini R, Paleologo G et al. IgA nephropathy: preliminary results of low-antigen content diet. Arch Intern Med 1992;152:429–38.

    Article  PubMed  CAS  Google Scholar 

  9. Sato M, Takayama K, Kojima H et al. Sodium cromoglycate therapy in IgA nephropathy: a preliminary short-term trial. Am J Kidney Dis 1990;15:141–6.

    PubMed  CAS  Google Scholar 

  10. Bazzi C, Sinico RA, Petrini C et al. Low doses of drug able to alter intestinal mucosal permeability to food antigens (5-aminosalicylic acid and sodium cromoglycate) do not reduce proteinuria in patients with IgA nephropathy: a preliminary non-controlled trial. Nephron 1992;61:192–5.

    PubMed  CAS  Google Scholar 

  11. Kincaid-Smith P, Nicholls K. Mesangial IgA nephropathy. Am J Kidney Dis 1983;3:90–102.

    PubMed  CAS  Google Scholar 

  12. Clarkson AR, Woodroffe AJ. Therapeutic perspectives in mesangial IgA nephropathy. Contrib Nephrol 1984;40:187–94.

    PubMed  CAS  Google Scholar 

  13. Iino Y, Ambe K, Kato Y et al. Chronic tonsillitis and IgA nephropathy. Acta Laryngol 1993;508(Suppl.):29–35.

    CAS  Google Scholar 

  14. Clarkson AR, Seymour AE, Woodroffe AJ et al. Controlled trial of phenytoin therapy in IgA nephropathy. Clin Nephrol 1980;13:215–18.

    PubMed  CAS  Google Scholar 

  15. Egido J, Rivera F, Sancho J et al. Phenytoin in IgA nephropathy: a long-term controlled trial. Nephron 1984;38:30–9.

    PubMed  CAS  Google Scholar 

  16. Tomino Y, Sakai H, Miura M et al. Effect of danazol on solubilization of immune deposits in patients with IgA nephropathy. Am J Kidney Dis 1984;4:135–40.

    PubMed  CAS  Google Scholar 

  17. Lai KN, MacMoune Lai F, Leung ACT et al. Plasma exchange in patients with rapidly progressive idiopathic IgA nephropathy: a report of two cases and review of the literature. Am J Kidney Dis 1987;10:66–70.

    PubMed  CAS  Google Scholar 

  18. Roccatello D, Ferro M, Coppo R et al. Report on intensive treatment of extracapillary glomerulonephritis with focus on crescentic IgA nephropathy. Nephrol Dial Transplant 1995;10:2054–9.

    PubMed  CAS  Google Scholar 

  19. Welch TR, McAdams AJ, Berry A. Rapidly progressive IgA nephropathy. Am J Dis Child 1988;142:789–93.

    PubMed  CAS  Google Scholar 

  20. Lai KN, Lai FM, Ho CP et al. Corticosteroid therapy in IgA nephropathy with nephrotic syndrome: a long-term controlled trial. Clin Nephrol 1986;26:174–80.

    PubMed  CAS  Google Scholar 

  21. Welch TR, Fryer C, Shely E et al. Double blind controlled trial of short term prednisone therapy in immunoglobulin A glomerulonephritis. J Pediatrics 1992;121:474–7.

    Article  CAS  Google Scholar 

  22. Waldo FB, Wyatt R, Kelly DR et al. Treatment of IgA nephropathy in children: efficacy of alternate-day oral prednisone. Pediatr Nephrol 1993;7:529–32.

    Article  PubMed  CAS  Google Scholar 

  23. Kobayashi Y, Fujii K, Hiki Y et al. Steroid therapy in IgA nephropathy: a retrospective study in heavy proteinuric cases. Nephron 1988;48:12–17.

    PubMed  CAS  Google Scholar 

  24. Kobayashi Y, Hiki Y, Kokubo T et al. Steroid therapy during the early stage of progressive IgA nephropathy. Nephron 1996;72:237–42.

    PubMed  CAS  Google Scholar 

  25. Woo KT, Lee GSL, Lau YK et al. Effects of triple therapy in IgA nephritis: a follow-up study 5 years later. Clin Nephrol 1991;36:60–6.

    PubMed  CAS  Google Scholar 

  26. Walker RG, Yu SH, Owen JE et al. The treatment of mesangial IgA nephropathy with cyclophosphamide, dipyridamole amd warfarin: a two-year prospective trial. Clin Nephrol 1990;34:103–7.

    PubMed  CAS  Google Scholar 

  27. Lagrue G, Bernard D, Bariety J et al. Traitment par la chlorambucil et azathioprine dans les glomerulonephrites primitives. Resultats d’une etude ‘controlee’. J Urol Nephrol 1975;9:655–72.

    Google Scholar 

  28. Andreoli SP, Bergstein JM. Treatment of severe IgA nephropathy in children. Pediatr Nephrol 1989;3:248–53.

    Article  PubMed  CAS  Google Scholar 

  29. Goumenos D, Ahuja M, Shortland JR et al. Can immunosuppressive drugs slow the progression of IgA nephropathy? Nephrol Dial Transplant 1995;10:1173–81.

    PubMed  CAS  Google Scholar 

  30. Lai KN, Mac-Moune Lai F, Li PKT et al. Cyclosporin treatment of IgA nephropathy: a short term controlled trial. Br Med J 1987;295:1165–8.

    CAS  Google Scholar 

  31. Rostoker G, Desvaux-Belghiti D, Pilatte Y et al. High-dose immunoglobulin therapy for severe IgA nephropathy and Henoch-Schönlein purpura. Ann Intern Med 1994;120:476–84.

    PubMed  CAS  Google Scholar 

  32. Rostoker G, Desvaux-Belghiti D, Pilatte Y et al. Immunomodulation with low-dose immuno-globulins for moderate IgA nephropathy and Henoch-Schönlein purpura. Preliminary results of a prospective uncontrolled trial. Nephron 1995;69:327–34.

    PubMed  CAS  Google Scholar 

  33. Furuse A, Hiramatsu M, Adachi N et al. Dramatic response to corticosteroid therapy of nephrotic syndrome associated with IgA nephropathy. Int J Pediatr Nephrol 1985;6:205–6.

    PubMed  CAS  Google Scholar 

  34. Clive DM, Galvanek DG, Silva FG. Mesangial immunoglobulin A deposits in minimal change nephrotic syndrome: a report of an older patient and a review of the literature. Am J Nephrol 1990;10:31–6.

    PubMed  CAS  Google Scholar 

  35. Johnson RJ. The glomerular response to injury. Mechanisms of progression or resolution. Kidney Int 1994;45:1769–82.

    Article  PubMed  CAS  Google Scholar 

  36. Feehally J. Immunoglobulin A nephropathy: fish oils and beyond. Curr Opin Nephrol Hypertens 1996;5:442–6.

    PubMed  CAS  Google Scholar 

  37. Hunley TE, Julian BA, Phillips JA et al. Angiotensin converting enzyme gene polymorphism: potential silencer motif and impact on progression in IgA nephropathy. Kidney Int 1996;49: 571–7.

    Article  PubMed  CAS  Google Scholar 

  38. Yoshida H, Mitari T, Kawamura T et al. Role of the deletion polymorphism of the angiotensin converting enzyme gene in the progression and therapeutic responsiveness of IgA nephropathy. J Clin Invest 1995;96:2162–9.

    Article  PubMed  CAS  Google Scholar 

  39. van Essen GG, Rensma PL, de Zeeuw D et al. Association between angiotensin-converting enzyme gene polymorphism and failure of renoprotective therapy. Lancet 1996;347:94–5

    Article  PubMed  Google Scholar 

  40. Chan MK, Kwan SYL, Chan KW et al. Controlled trial of antiplatelet agents in mesangial IgA glomerulonephritis. Am J Kidney Dis 1987;9:417–21.

    PubMed  CAS  Google Scholar 

  41. Lee GS, Choong HL, Chiang GSC, Woo KT. 3 year randomised controlled trial of dipyridamole and low-dose warfarin in patients with IgA nephropathy with renal impairment. Nephrology 1997;3:117–21.

    CAS  Google Scholar 

  42. Miura M, Endoh M, Nomoto Y et al. Long-term effect of urokinase therapy in IgA nephropathy. Clin Nephrol 1989;32:209 16.

    PubMed  Google Scholar 

  43. Maschio G, Cagnoli L, Claroni F et al. ACE inhibition reduces proteinuria in normotensive patients with IgA nephropathy: a multicentre, randomised placebo-controlled trial. Nephrol Dial Transplant 1994;9;265–9.

    PubMed  CAS  Google Scholar 

  44. Rekola S, Bergstrand A, Bucht H et al. Deterioration rate in hypertensive IgA nephropathy: comparison of a converting enzyme inhibitor and β-blocking agents. Nephron 1991;59:57–60.

    Article  PubMed  CAS  Google Scholar 

  45. Cattran D, Greenwood C, Ritchie S. Long-term benefits of angiotensin-converting enzyme inhibitor therapy in patients with severe immunoglobulin A nephropathy: a comparison to patients receiving treatment with other antihypertensive agents and to those receiving no therapy. Am J Kidney Dis 1994;23:247–54.

    PubMed  CAS  Google Scholar 

  46. Bannister KM, Weaver A, Clarkson AR, Woodroffe AJ. Effect of angiotensin-converting enzyme and calcium channel inhibition on progression of IgA nephropathy. Contrib Nephrol 1995;111:184–93.

    PubMed  CAS  Google Scholar 

  47. Donadio JV, Bergstalh EJ, Offord KP et al. A controlled trial of fish oil in IgA nephropathy. N Engl J Med 1994;331:1194–9.

    Article  PubMed  Google Scholar 

  48. Hamazaki T, Tateno S, Shishido H. Eicosapentanoic acid and IgA nephropathy. Lancet 1984;i: 1017–18.

    Article  Google Scholar 

  49. Bennett WM, Walker RG, Kincaid-Smith P. Treatment of IgA nephropathy with eicosapentanoic acid (EPA): a two-year prospective trial. Clin Nephrol 1989;31:128–9.

    PubMed  CAS  Google Scholar 

  50. Pettersson EE, Rekola S, Berglund L et al. Treatment of IgA nephropathy with omega-3-polyunsaturated fatty acids:a prospective, double-blind, randomised study. Clin Nephrol 1994;41:183–90.

    PubMed  CAS  Google Scholar 

  51. Cheng IKP, Chan PCK, Chan MK. The effects of fish-oil dietary supplementation on the progression of mesangial IgA glomerulonephritis. Nephrol Dial Transplant 1990;5:241–6.

    PubMed  CAS  Google Scholar 

  52. Odum J, Peh CA, Clarkson AR et al. Recurrent mesangial IgA nephritis following renal transplantation. Nephrol Dial Transplant 1994;9:309–12.

    PubMed  CAS  Google Scholar 

  53. Oner A, Tinaztepe K, Erdogan O. The effect of triple therapy on rapidly progressive type of Henoch-Schönlein nephritis. Pediatr Nephrol 1995;9:6–10.

    Article  PubMed  CAS  Google Scholar 

  54. Jardim H, Leake J, Risdon RA et al. Crescentic glomerulonephritis in children. Pediatr Nephrol 1992, 6:231–5.

    Article  PubMed  CAS  Google Scholar 

  55. Haycock GB. The nephritis of Henoch-Schönlein purpura. In: Cameron S, Davison AM, Grunfeld J-P, Kerr D, Ritz E, editors. Oxford Textbook of Clinical Nephrology. Oxford: Oxford University Press; 1992:595–612.

    Google Scholar 

  56. Mollica F, LiVolti S, Garozzo R, Russo G. Effectiveness of early prednisone treatment in preventing the development of nephropathy in anaphylactoid purpura. Eur J Pediatr 1992;151: 140–4.

    Article  PubMed  CAS  Google Scholar 

  57. Saulsbury FT. Corticosteroid therapy does not prevent nephritis in Henoch-Schönlein purpura. Pediatr Nephrol 1993;7:69–71.

    Article  PubMed  CAS  Google Scholar 

  58. Hasegawa A. Fate of renal grafts with recurrent Henoch-Schönlein purpura nephritis in children. Transplant Proc 1989;21:2130.

    PubMed  CAS  Google Scholar 

  59. Habib R. Purpura rheumatoide. In: Royer P, Habib R, Mathieu H, Broyer M, editors. Nephrologie Pediatrique. Paris: Flammarion;1983:342–68.

    Google Scholar 

Download references

Authors
  1. J. Feehally
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Imperial College School of Medicine, Hammersmith Hospital, London, UK

    C. D. Pusey

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Kluwer Academic Publishers

About this chapter

Cite this chapter

Feehally, J. (1999). IgA nephropathy and Henoch-Schönlein purpura. In: Pusey, C.D. (eds) The Treatment of Glomerulonephritis. Developments in Nephrology, vol 40. Springer, Dordrecht. https://doi.org/10.1007/978-0-585-37972-2_6

Download citation

  • DOI: https://doi.org/10.1007/978-0-585-37972-2_6

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-0-7923-5332-4

  • Online ISBN: 978-0-585-37972-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation