Saturday, February 6, 2010

IN THE NEWS --> IgA with ANCAs

The Feb 2010 issue of AJKD describes an interesting entity of IgA Nephropathy with ANCA presenting with crescentic disease on biopsy.  This is interesting since IgA deposits are so common worldwide, why can't someone have 2 glomerular processes at the same time.  They studied 8 patients with crescentric IgA associated with ANCAs (MPO and PR3) against 26 patients with pure IgA crescentric disease without ANCAs.
Not to their surprise, they found that the first entity was more aggressive but the 8 patients with ANCA and IgA responded to aggressive immunosuppresive therapy much better than the 26 with just IgA disease. This is an interesting read and perhaps points out a possible new entity of an aggressive IgA disease. They noticed no significant improvement in kidney function in the ANCA negative patients with RPGN IgA disease.  Its possible that those patients were not that aggressively treated as an ANCA positive disease might have been treated.  An aggressive IgA with creascents should also be treated as an RPGN regardless of ANCA or no ANCA.
Image source: CIN  2003( 3rd Congress of Nephrology in Internet)
Something to watch out for.

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