IgA Nephritis: Terminal Hematuria
IgA nephropathy (IgAN), also known as Berger's disease, is the most common primary glomerulonephritis worldwide. It is characterized by the deposition of IgA immune complexes in the glomerular mesangium, leading to inflammation and progressive kidney damage. Terminal hematuria, defined as microscopic or macroscopic hematuria that persists at the end of micturition, is a common manifestation of IgAN. It occurs in approximately 20-40% of patients and can be a sign of severe disease activity.
Causes of Terminal Hematuria in IgA Nephritis
The exact mechanism underlying terminal hematuria in IgAN is not fully understood, but several factors are thought to contribute:
- Glomerular inflammation: The inflammatory process in the glomeruli can damage the capillary walls, leading to leakage of red blood cells into the urine.
- Increased glomerular permeability: The deposition of IgA immune complexes can alter the structure of the glomerular basement membrane, making it more permeable to red blood cells.
- Tubular injury: The inflammatory process can extend to the renal tubules, causing damage and impaired reabsorption of red blood cells.
- Urothelial injury: The passage of red blood cells through the urinary tract can irritate the urothelium, leading to inflammation and bleeding.
Clinical Significance of Terminal Hematuria in IgA Nephritis
Terminal hematuria is often a sign of more severe disease activity in IgAN. It is associated with:
- Increased risk of progression to end-stage renal disease (ESRD): Patients with terminal hematuria have a higher risk of developing ESRD compared to those without hematuria.
- Proteinuria: Terminal hematuria is often accompanied by proteinuria, which is another indicator of glomerular damage.
- Hypertension: Hypertension is a common complication of IgAN, and it can be more severe in patients with terminal hematuria.
- Acute kidney injury: Terminal hematuria can be a sign of acute kidney injury, which is a sudden decline in kidney function.
Management of Terminal Hematuria in IgA Nephritis
The management of terminal hematuria in IgAN depends on the severity of the disease and the underlying cause. Treatment options include:
- Conservative therapy: In patients with mild hematuria, conservative measures such as rest, hydration, and avoidance of strenuous activity may be sufficient to control bleeding.
- Medications: Medications that can reduce inflammation and glomerular permeability may be used to treat terminal hematuria in IgAN. These include corticosteroids, immunosuppressive drugs, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).
- Surgery: In severe cases, surgery may be necessary to control bleeding. This may involve laser coagulation of the affected glomeruli or partial nephrectomy (removal of a portion of the kidney).
Prognosis of Terminal Hematuria in IgA Nephritis
The prognosis of terminal hematuria in IgAN depends on the severity of the underlying disease and the patient's overall health. In patients with mild hematuria and well-controlled disease, the prognosis is generally good. However, in patients with severe hematuria and progressive kidney damage, the prognosis may be less favorable.
Conclusion
Terminal hematuria is a common manifestation of IgA nephropathy and can be a sign of severe disease activity. The management of terminal hematuria depends on the severity of the disease and the underlying cause. Treatment options include conservative therapy, medications, and surgery. The prognosis of terminal hematuria in IgAN depends on the severity of the underlying disease and the patient's overall health.
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Topic: #nephritis #iga #hematuria
