Role of kidney biopsy in immunoglobulin a nephropathy
Should a kidney biopsy always be performed in immunoglobulin a nephropathy?
No. Asymptomatic patients with isolated hematuria or mild proteinuria (<500 mg/day) usually follow a benign course.
General interventions known to slow progression that are used in other cases of chronic kidney disease should be implemented.
Given that histologic findings at this stage of disease are not likely to alter therapy and considering the risk, a kidney biopsy is not warranted.
The decision to perform a biopsy in these cases even when immunoglobulin a nephropathy is highly suspected is a matter of debate.
Although biopsy can at least confirm the diagnosis, this decision varies widely among nephrologists and the affected patients as well as by geographic region.
Regardless of whether a kidney biopsy is performed, ongoing follow-up of these patients is imperative, because a more concerning phenotype may evolve at any time and is unpredictable.
Kidney biopsy is generally recommended in patients with an unexplained serum creatinine above normal for age and sex and/or proteinuria > 500 to 1000 mg/day.
