How is acute poststreptococcal glomerulonephritis (APSGN) differentiated from immunoglobulin A (IgA)–associated glomerulonephritis?

Updated: Dec 05, 2018
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

IgA-associated glomerulonephritis

Immunoglobulin A (IgA)–associated glomerulonephritis may be confused with acute poststreptococcal glomerulonephritis. [4, 18, 43, 56] In the form of IgA nephropathy associated with a typical anaphylactoid purpura (ie, Henoch-Schönlein purpura nephritis), the characteristic rash and the associated symptoms of either abdominal pain or arthritis and/or arthralgia help in the differentiation; however, in atypical cases, marked similarity may be present.

All of the clinical manifestations of APSGN have been reported in persons with Henoch-Schönlein purpura nephritis, although significant hypertension and edema are found less commonly in individuals with Henoch-Schönlein purpura than in those with APSGN. In addition, evidence of a previous streptococcal illness is usually lacking in individuals with Henoch-Schönlein purpura nephritis, and complement values (C3 and/or C4) are usually normal.

Urticarial or purpuric rashes, abdominal complaints, and arthritis and/or arthralgia are found almost exclusively in persons with Henoch-Schönlein purpura.

Berger disease or IgA nephropathy usually presents as an episode of gross hematuria occurring during the early stages of a respiratory illness; no latent period occurs, and hypertension or edema is uncommon.

Recurrent episodes of gross hematuria, associated with respiratory illnesses, followed by persistent microscopic hematuria, are highly suggestive of IgA nephropathy. In contrast, acute poststreptococcal glomerulonephritis usually does not recur, and second episodes are rare.


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