The Global Burden of Immunoglobulin - A Nephropathy: A Message for General Practitioners and Nephrologists

Immunoglobulin A nephropathy (IgAN) or Berger's disease is the most common primary glomerulonephritis worldwide, but there are large variations in geographical distribution. Recently, we have investigated the prevalence of the disease for analyzing the factors responsible for this difference. We have observed that: (1) Systematic mass screenings of urine in populations, as occurs in some Asian countries (Japan, Korea, and Dubai, UAE), are not a common practice in the Western countries, (2) General practitioners and healthcare professionals underestimate the persistent microscopic hematuria and/or mild proteinuria in apparently healthy individuals; this approach causes late referral to a nephrologist and (3) There are different indications for the kidney biopsy adopted by nephrologists in individuals with persistent urinary abnormalities. The aim of this lecture is to stimulate the medical community to go beyond these barriers because in all countries IgAN is potentially the largest diffuse kidney disease with an annual incidence of ˜40˜50 cases per million populations. This very common disease depicts two important aspects: (1) IgAN may have a heavy economic impact on the National Healthcare Systems because mainly children, youngsters, and adults in the 2nd and 3rd decade of life develops the disease; (2) 40% of these patients arrive in ESKD by 20 years from the biopsy-proven diagnosis when they are in a productive working time of their life. A great effort should be done for the early diagnosis of the disease in individuals who manifest persistent microhematuria and/or mild proteinuria. It is necessary to introduce more stringent indications for kidney biopsy. This preventive approach followed by early therapy may reduce the global burden of end-stage kidney disease caused by IgAN.

Author(s): Francesco Paolo Schena

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