What is the prognosis of immunoglobulin a nephropathy?
Most patients who present with isolated hematuria and no proteinuria have a low risk of progression provided these laboratory features do not change.
Among patients who develop significant persistent proteinuria > 500 to 1000 mg/day, approximately 25% to 30% will require renal replacement therapy (RRT) within 20 to 25 years of presentation.
A higher percentage will require RRT if they have persistent higher-grade proteinuria of more than 2000-3000 mg/day with or without hypertension. This is particularly true if the proteinuria cannot be reduced with therapy.
Spontaneous improvement in laboratory findings in those with isolated hematuria (without significant proteinuria or impairment of glomerular filtration rate [GFR]) has been reported.
It appears to be more common in children and has been estimated to occur in between 5% and 30% of such cases.
There is a geographic variability in immunoglobulin a nephropathy prognosis that is in large part explained by lead-time bias related to differing clinical thresholds for performing a kidney biopsy.
Calculating the influence of other factors such as genetics, diet, ethnicity, or treatment is relevant but currently impossible to quantitate.
