Case Studies

 Case 9.6 IgA nephropathy

A 14-year-old boy presented with an 18-month history of intermittent, painless haematuria, usually occurring after strenuous exercise, but without dysuria or increased frequency of micturition. He also had frequent colds and sore throats and believed that the haematuria increased at these times. On examination, he appeared fit and healthy; his blood pressure was 120/75. Urine analysis showed microscopic haematuria (3+) and a trace of protein. Intravenous urography, a micturating cystogram and cystoscopy were normal. His haemoglobin, white-cell count, blood urea and creatinine clearance were normal; the urinary protein excretion was 0.95g/day. Immunoglobulin, CH₅₀, C4 and C3 levels were within normal limits. In view of the duration of haematuria, a renal biopsy was performed. Twelve glomeruli were present: all showed a diffuse increase in mesangial cells with thickening of the matrix. Immunofluorescent examination of the biopsy showed mesangial deposits of IgA and C3. The appearances were characteristic of IgA nephropathy.