Thursday, May 1, 2014

Consult Rounds: IgA nephropathy and TMA- does it have a connection?

IgA and thrombotic microangiopathy?- is there a link?
1.      They studied over 100 patients retrospectively at a single center and looked at biopsy findings of IgA nephropathy patients with follow up for 44 months
2.      Over 50% had TMA findings on biopsy.
3.      One would presume most of this might be HTN related to the IgA that leads to TMA.  4% were normotensive, 25% had controlled hypertension, and 71% had uncontrolled hypertension.
4.      The biopsies with TMA had most fibrosis and tubular atrophy
5.      TMA with IgA nephropathy also had significant protienuria.
6.      Renal survival was 52.2% at 44 months among the TMA patients versus 93.5% among those without TMA (P=0.00001).
7.      IgAN-associated TMA remains a primarily arterial/arteriolar lesion resembling like scleroderma
8.      What else besides HTN can lead to this in IgA? Endothelial damage is what is presumed to the most likely cause.
9.      Anti-phospholipid syndrome antibodies have also been described in IgAN. In their series, it was no the major cause.
10.  Decreased VEGF and or anti endothelial antibodies are presumed to be other causes
11.  Could this resemble some form of secondary variant of IgA nephropathy perhaps from a virus or infection or other systemic disease?
12.  If the incidence of TMA in Ig A nephropathy is this high, then why is this not part of the Oxford classification?
13.  Other studies that have looked at this


  1. What can muddy the waters here is the variability in calling TMA by pathologists. It's subjective in my opinion and may be called TMA or chronic vasculopathy depending on who reads it.

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