Pediatric IgA Nephropathy Follow-up
- Author: Mohammad Ilyas, MD, FAAP; Chief Editor: Craig B Langman, MD more...
Further Outpatient Care
Routine follow up is important for monitoring the progression of disease.
Medications must be taken as prescribed.
A healthy diet and lifestyle is important.
Patients should avoid obesity, smoking, and other activities that negatively influence the cardiovascular system.
Further Inpatient Care
Inpatient care is not necessary in patients with immunoglobulin A (IgA) nephropathy (IgAN), except for complications of renal failure, hypertension, dialysis, or renal transplantation.
Inpatient & Outpatient Medications
No specific change of medication is necessary to transition from inpatient to outpatient therapy.
No transfer is necessary.
No methods for deterrence or prevention of IgA nephropathy are known.
Primary complications include those related to uncontrolled hypertension (eg, seizure, stroke, end-organ damage), renal insufficiency (eg, growth failure, bone demineralization, anemia), and adverse reactions to one of the prescribed medications.
IgA nephropathy was initially thought to be a benign disease, but it is now recognized that over 25 years of observation, it can slowly progress to end-stage renal disease in up to 50% of affected patients. The remaining patients may sustain clinical remission or have persistent low-grade hematuria and/or proteinuria. The prognosis is difficult to predict with accuracy in an individual patient, but important risk factors for progressive renal disease have been identified.
Patients with IgA nephropathy who have little or no proteinuria (>500-1000 mg/d) have a low risk of progression, at least in the short term. However, proteinuria and renal insufficiency develop in a substantial proportion of patients over the long term. Among patients who develop overt proteinuria and/or an elevated serum creatinine concentration, the rate of progression to end-stage renal disease is approximately 15-25% at 10 years and 20-30% at 20 years.
The rate of progression is typically slow, with the glomerular filtration rate (GFR) often falling by as little as 1-3 mL/min/y, a change not associated with an elevation in the serum creatinine concentration in the short term. In one report, repeat renal biopsies were performed at 5 years in 73 patients with persistent proteinuria and a normal or near-normal initial serum creatinine value. Histologic improvement occurred in only 4%, with 41% remaining stable and 55% showing progressive glomerular and secondary vascular and tubulointerstitial injury. An increase in serum creatinine to more than 1.5 mg/dL (133 µmol/L) was associated with major pathologic lesions.
The patients who develop progressive disease typically have one or more of the following clinical or laboratory findings at diagnosis, each of which is a marker for more severe disease.
- A reduction in GFR, as manifested by an elevated serum creatinine concentration at diagnosis or during the course of the disease, is associated with a worse renal prognosis
- Hypertension (BP >95 percentile for height and sex) is predictive of a worse outcome; a higher mean arterial pressure is associated with a higher risk of progressive renal disease
- With regard to proteinuria, the rate of progression is very low among patients excreting less than 15 mg/kg/d and is greatest among those excreting more than 50 mg/kg/d
Inform patients about specific disease processes when possible.
Encourage patients to avoid risk factors, such as smoking, drugs, obesity, and poor medication compliance.
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