From the Guidelines
Elevated immunoglobulin A (IgA) is concerning and may indicate underlying health conditions that require medical attention, particularly IgA nephropathy, which can lead to progressive kidney disease if not properly managed. IgA elevations are commonly associated with chronic liver disease, autoimmune disorders, infections, inflammatory bowel diseases, and certain cancers. The clinical significance of elevated IgA depends on the degree of elevation and associated symptoms. According to the 2021 KDIGO guideline for the management of glomerular diseases 1, patients with suspected IgAN should undergo a kidney biopsy to confirm the diagnosis and determine risk stratification and treatment options.
Key Considerations
- Elevated IgA levels can be associated with various health conditions, including IgA nephropathy, which requires prompt medical attention to prevent progressive kidney disease.
- A kidney biopsy is essential for diagnosing IgAN and determining the MEST-C score, which helps assess disease prognosis 1.
- The management of IgAN should focus on optimized supportive care, including RAS blockade, blood pressure control, and cardiovascular risk minimization 1.
- Patients with high-risk IgAN may be considered for a 6-month course of glucocorticoid therapy or participation in a therapeutic clinical trial 1.
Diagnostic Approach
- Further diagnostic testing, including liver function tests, kidney function assessment, and possibly protein electrophoresis, is recommended to rule out underlying conditions that may be causing elevated IgA levels.
- The 2023 KDOQI US commentary on the 2021 KDIGO clinical practice guideline for the management of glomerular diseases suggests that patients with suspected IgAN and higher levels of proteinuria or diminished eGFR warrant a kidney biopsy to confirm the diagnosis and determine risk stratification and treatment options 1.
Treatment Approach
- Treatment should target the underlying cause of elevated IgA rather than the elevation itself, and may involve RAS blockade, glucocorticoids, or other immunosuppressive therapies in certain cases 1.
- The use of immunosuppressive therapies, such as azathioprine, cyclophosphamide, and rituximab, is not recommended in IgAN, except in specific situations, such as rapidly progressive IgAN 1.
From the Research
Elevated Immunoglobulin A Concerns
Elevated immunoglobulin A (IgA) levels can be concerning as they may indicate various conditions and diseases.
- IgA is one of the five classes of immunoglobulins, making up about 15% of the immunoglobulins in normal serum 2.
- Quantitative serum immunoglobulin tests are used to detect abnormal levels of IgA, IgG, and IgM, which can help diagnose conditions such as immunoglobulin A nephropathy (IgAN) 2, 3.
Immunoglobulin A Nephropathy
IgAN is a condition where IgA deposits accumulate in the kidneys, leading to inflammation and damage.
- A study published in 2014 found that urinary β2-microglobulin levels were significantly correlated with renal function and proteinuria in IgAN patients, suggesting its potential as a prognostic marker 3.
- The study included 51 patients with biopsy-proven IgAN and found that urinary β2-microglobulin levels were associated with disease progression 3.
Laboratory Tests
Laboratory tests such as the complete blood count (CBC) can provide valuable information about a patient's condition.
- The CBC includes various components, such as red and white blood cell counts, hemoglobin, and platelet count, which can help diagnose and monitor hematologic disorders and other medical problems 4, 5.
- Understanding the components and limitations of the CBC can aid in difficult diagnoses and inform treatment plans 4, 5.