Primary IgA nephropathy

　　The exact pathogenesis of IgA nephropathy is not fully understood, and it is related to multiple factors. Currently, the consensus is that IgA nephropathy belongs to glomerulonephritis caused by immune complexes.

　　1, Relationship with the immune system:IgA nephropathy is mainly characterized by the deposition of polymeric IgA (PIgA) in the glomerular mesangial area, indicating that the IgA immune system leads to the appearance of PIgA molecules in the circulatory system and their deposition in the glomerular mesangial area.

　　2, Relationship with the bone marrow:The IgA1 deposited in the glomerular mesangial area, and the similar hinge region glycosylation abnormality in the IgA-1 in the blood, suggests that the IgA deposited in the glomerular mesangial area of IgA nephropathy patients is of myeloid origin.

　　3, Relationship with cytokines:The IgA-1 deposited in the mesangial area of IgA nephropathy patients causes mesangial cells to secrete inflammatory factors.

　　The main complications caused by primary IgA nephropathy include hematuria, proteinuria, renal insufficiency, and renal failure, as follows:

　　1, Hematuria and proteinuria

　　Hematuria and proteinuria are the most common complications in IgA nephropathy patients, and they usually manifest as hematuria or proteinuria, with both occurring simultaneously rarely. After the appearance of gross hematuria in IgA nephropathy patients, symptoms of general discomfort may occur. Severe patients may have persistent proteinuria and hematuria.

　　2, Renal insufficiency

　　Patients with IgA nephropathy may experience severe hypertension after the onset of the disease. If the disease is not effectively controlled, hypertension can lead to atherosclerosis of the human arteries, further damaging renal function, and ultimately causing renal insufficiency.

　　3, Renal failure

　　In addition to the complications mentioned above, IgA nephropathy patients may also experience renal failure. This is mainly due to the lack of systematic treatment for IgA nephropathy, leading to gradual damage to the patient's renal function and ultimately deteriorating into severe renal failure or uremia.

　　IgA nephropathy often occurs after upper respiratory tract infection (or acute gastroenteritis, peritonitis, osteomyelitis, etc.), with gross hematuria that is prone to recurrence appearing 1 to 3 days later, lasting for several hours to several days and may transform into microscopic hematuria. It may be accompanied by abdominal pain, lumbar pain, muscle pain, or low fever. Some patients may find urinary abnormalities during physical examination, which are asymptomatic proteinuria and (or) microscopic hematuria. A few patients may have persistent gross hematuria and varying degrees of proteinuria, which may be accompanied by edema and hypertension. Most patients have no abnormal signs, and some may have renal area tenderness, edema, and mild to moderate blood pressure elevation. A preliminary diagnosis of IgA nephropathy (inflammation) can be made based on clinical findings, and definitive diagnosis requires renal tissue immunopathological examination.

　　Prevent colds and overexertion, use nephrotoxic drugs with caution, and treat infections with antibiotics. Take adequate rest and avoid strenuous exercise. However, when the condition is stable, pay attention to appropriate exercise. Enhance disease resistance, avoid catching colds, reduce the opportunity for infection, and apply strong antibiotics in a timely manner to control infections as soon as various infections occur. For those with recurrent attacks of chronic tonsillitis, tonsillectomy can be performed.

　　Primary IgA nephropathy is usually mild to moderate proteinuria (

　　The diet for primary IgA nephropathy should be light, and it is advisable to eat more fruits, vegetables, and high-quality protein foods. Eggs, milk, dairy products, vegetables, and fruits can be consumed appropriately, which is helpful for improving the patient's nutrition and restoring their physical condition. Spicy, fatty, and greasy foods, moldy products, preserved foods, and alcohol should be avoided.

　　The Western medical treatment methods for primary IgA nephropathy mainly include general treatment, drug treatment, and hemodialysis therapy, as follows:

　　1. General Treatment

　　Prevent colds and overexertion, use nephrotoxic drugs with caution. Antibiotics should be given for infections. For those with recurrent attacks of chronic tonsillitis, tonsillectomy can be performed.

　　2. Drug Therapy

　　1. Those with significant hematuria can be treated with Tripterygium glycosides, dipyridamole, ACE inhibitors, and large doses of vitamin C orally.

　　2. Those presenting with nephrotic syndrome should refer to the chapter on nephrotic syndrome for treatment.

　　3. Those with the same manifestations as chronic glomerulonephritis should be treated according to the treatment for chronic glomerulonephritis.

　　4. Pathological examination with predominant crescent formation and IgA deposition can be treated with intensified plasma exchange therapy and medication (see treatment for rapid progressive glomerulonephritis).

　　3. Hemodialysis Therapy

　　Patients with acute renal failure or those with chronic renal failure should undergo hemodialysis or peritoneal dialysis treatment.