Monitoring
All patients diagnosed with IgAV should be followed for at least 6 months with urinalysis monitoring.[29][54] An abnormality on urinalysis should be followed by a blood pressure check and spot urine sample to quantify the protein concentration (urine albumin:creatinine ratio or urine protein:creatinine ratio), serum creatinine, and serum albumin. Patients with persistent proteinuria or renal insufficiency should be referred to a nephrologist for further evaluation.
Absolute indications for renal biopsy:[55]
Persistent severe proteinuria (urine protein:creatinine ratio >250 mg/mmol at least 4 weeks after diagnosis)
Persistent moderate proteinuria (urine protein:creatinine ratio 100-250 mg/mmol for 3 months)
Acute kidney injury stage 1 or greater (serum creatinine >1.5 x previous baseline [if known] or >1.5 x upper limit of normal for age)
Nephrotic syndrome (clinical edema, serum albumin below lower limit of normal for age, moderate/severe proteinuria).
Relative indications for renal biopsy:[55]
Reproducible severe proteinuria (urine protein:creatinine ratio >250 mg/mmol) at any time point
Serum creatinine above upper limit of normal.
UK guidelines recommend that children with biopsy-proven nephritis should have long-term follow-up while there is evidence of nephritis and for at least 3 years.[33]
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