Diagnostic Approach Ig A Nephropathy

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Diagnostic Approach Ig A Nephropathy

  1. 1. Diagnostic approach Ig A nephropathy D.Agiimaa M.Tsendsuren Ph.D P.Chuluunhuu
  2. 2. Introduction <ul><li>Ig A nephropathy: </li></ul><ul><ul><li>First described by Berger and Hinglais in 1968 </li></ul></ul><ul><ul><li>Primary glomerulonephritis </li></ul></ul><ul><ul><li>Circulating IgA immune complexes-mediated </li></ul></ul><ul><ul><li>Similar in terms of pathogenesis with Shonlein-Henokh </li></ul></ul>
  3. 3. Frequency <ul><li>Ig A nephropathy: </li></ul><ul><ul><li>Japan 50% (James V. 2002) </li></ul></ul><ul><ul><li>Asia, Australia, South Europe 30-40% </li></ul></ul><ul><ul><li>North Europe 20% </li></ul></ul><ul><ul><li>(NIH GUIDE. 2005) </li></ul></ul><ul><ul><li>USA 2-10% (Neiberger R. 2004) </li></ul></ul><ul><ul><li>Mongolia ? </li></ul></ul>
  4. 4. <ul><li>IgA NP: </li></ul><ul><ul><li>3-16 year-old (À.V.Papayan 1997) </li></ul></ul><ul><ul><li>Sex-Male>Female </li></ul></ul><ul><ul><ul><li>M:F/1:2 (T.Melvin, V.Kim 1987) </li></ul></ul></ul><ul><ul><ul><li>79,2% (T.Linne 1991 ) </li></ul></ul></ul>
  5. 5. Clinical presentation <ul><li>60-80% gross hematuria & micro hematuria </li></ul><ul><li>12% Acute Nephritis </li></ul><ul><li>10% Nephrotic Syndrome </li></ul><ul><li>1% Cresentic or RPGN </li></ul><ul><li>(R.Neiberger 2004) </li></ul>
  6. 6. <ul><li>Serum IgA </li></ul><ul><ul><li>elevation in only 8-16% of children </li></ul></ul><ul><ul><li>(Neiberger R. 2004) </li></ul></ul><ul><li>Kidney biopsy </li></ul><ul><ul><li>presence of glomerular IgA deposits accompanied by a variety of histopathologic lesions </li></ul></ul>Diagnosis
  7. 7. <ul><li>Ig AN </li></ul><ul><ul><li>Poor prognosis </li></ul></ul><ul><ul><ul><li>From 15 to 40 percent of patients will eventually have end-stage renal disease </li></ul></ul></ul><ul><ul><ul><li>( James V. Donadio et al. 2002 ) </li></ul></ul></ul><ul><ul><ul><li>as many as 30-50% of cases progress to end-stage renal failure in 10 years </li></ul></ul></ul><ul><ul><ul><li>(Neiberger R. 2004) </li></ul></ul></ul><ul><li>Main cause of CRF in children in MCHRC </li></ul><ul><ul><li>glomerulonephritis 51.6% </li></ul></ul><ul><ul><ul><li>Nephrotic+Hematuric syndrome 41% </li></ul></ul></ul><ul><ul><ul><li>Shonlein-Henoch nephritis 31% </li></ul></ul></ul><ul><ul><ul><li>Hematuric syndrome 19% </li></ul></ul></ul><ul><ul><ul><li>Nephrotic syndrome 9% </li></ul></ul></ul><ul><ul><li>(Ì. Tsendsuren et al. 2005) </li></ul></ul>
  8. 8. Rationale <ul><li>MCH Center is a referral hospital which provides pediatric nephrology service for whole country. </li></ul><ul><li>Glomerulonephritis is one of the main causes of renal morbidity and CRF among children admitted to the Nephrology Department, MCH Center. </li></ul><ul><li>IgA nephropathy is the most primitive glomerulonephritis, and requires the renal biopsy. </li></ul><ul><li>So far, all types of glomerulonephritis were treated by syndromes in Mongolia. </li></ul><ul><li>There is an urgent needs to differentiate by biopsy glomerulonephritis and IgA nephropathy since they require different treatments. </li></ul>
  9. 9. Aim of the study <ul><li>To establish a new diagnostic method of IgA N among children in Mongolia </li></ul><ul><ul><li>To identify and compare clinical and laboratory features (serum IgA) among children with IgAN and Shonlein-Henoch nephritis </li></ul></ul><ul><ul><li>To perform kidney biopsy among children with IgAN and Shonlein-Henoch nephritis </li></ul></ul>
  10. 10. Materials and Methods <ul><li>Study: Case-control study </li></ul><ul><ul><li>In the department of nephrology of the MCH Center </li></ul></ul><ul><ul><li>During 2006-2008 </li></ul></ul><ul><ul><li>Age 3-18 years </li></ul></ul><ul><ul><li>40 children with IgA N and 120 children with Shonlein-Henoch nephritis (case:control/1:3) </li></ul></ul><ul><li>Statistical analysis </li></ul><ul><ul><li>SPSS 11.5 for windows program </li></ul></ul>
  11. 11. Outcome <ul><li>A new diagnostic approach for Ig A nepropathy </li></ul>

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