Monitoring for vasculitic IgA nephritis

For people with IgA vasculitis without evidence of significant nephritis (ie normotensive, normal urinalysis or isolated microscopic haematuria only), the general practitioner can monitor according to the following schedule:

• weekly BP measurement and early morning urinalysis for the first month
• fortnightly BP measurement and early morning urinalysis for the second and third months
• one-off BP measurement and early morning urinalysis at 6 and 12 months
• continue to measure BP and early morning urinalysis annually if isolated microscopic haematuria persists at 12 months
• restart the monitoring schedule from the beginning if there is a flare of cutaneous or gastrointestinal symptoms
• at any time during this schedule, if the person develops evidence of kidney involvement, refer to Management approach for people with immunoglobulin A (IgA) vasculitis who develop evidence of kidney involvement during monitoring for a management approach.

For people with IgA vasculitis who develop evidence of kidney involvement (ie hypertension, macroscopic haematuria or proteinuria) during monitoring, the general practitioner (or paediatrician or physician) can use the following approach:

• perform a detailed clinical review, including measurement of height, weight and blood pressure
• assess urine microscopy, and urinary protein to creatinine ratio, on an early morning urine sample
• assess blood investigations—albumin, creatinine, urea and electrolytes, full blood count and coagulation profile.

Investigation findings that warrant consultation with a nephrologist are listed in Abnormal parameters in immunoglobulin A (IgA) vasculitis that warrant consultation with a nephrologist.

For people with IgA vasculitis and suspected IgA nephritis, consult a nephrologist if any of the following abnormal parameters are found:

• acute nephritic syndrome—macroscopic haematuria, proteinuria, oedema, hypertension and oliguria
• nephrotic syndrome—urinary protein to creatinine ratio more than 250 mg/mmol, serum albumin less than 25 g/L, and oedema
• macroscopic haematuria for 5 consecutive days
• elevated urinary protein to creatinine ratio of
  • more than 250 mg/mmol for less than 4 weeks (measured weekly), but rising
  • more than 250 mg/mmol for 4 weeks (measured weekly)
  • more than 100 mg/mmol for 3 months (persistent)
  • more than 50 mg/mmol for 6 months (persistent)
• abnormal kidney function
• confirmed hypertension. [NB1] [NB2]

Continue to monitor disease activity if the patient has proteinuria that does not warrant nephrology review (based on the parameters above).