IgA Nephropathy vs Post-Streptococcal Glomerulonephritis
IgA Nephropathy and Post-Streptococcal Glomerulonephritis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
IgA Nephropathy vs Post-Streptococcal Glomerulonephritis at a glance
- IgA Nephropathy: Most common primary glomerulonephritis; mesangial IgA deposits with synpharyngitic hematuria.
- Post-Streptococcal Glomerulonephritis: Immune complex GN 1-3 weeks after group A strep pharyngitis or impetigo.
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Side-by-side comparison
| Feature | IgA Nephropathy | Post-Streptococcal Glomerulonephritis |
|---|---|---|
| At a glance | Most common primary glomerulonephritis; mesangial IgA deposits with synpharyngitic hematuria. | Immune complex GN 1-3 weeks after group A strep pharyngitis or impetigo. |
| Classic presentation | Recurrent episodes of cola-colored urine within 24-72 hours of a URI = synpharyngitic hematuria of IgA nephropathy.; Gross hematuria within 1-3 days of URI, GI infection, or vigorous exercise (synpharyngitic); Asymptomatic microscopic hematuria (most common presentation); Flank pain during gross hematuria episodes; Edema and… | Cola-colored urine + periorbital edema + hypertension in a child 1-3 weeks after sore throat or impetigo = classic PSGN.; Abrupt onset of tea-colored or cola-colored urine (gross hematuria) 1-3 weeks after pharyngitis or 3-6 weeks after impetigo; Periorbital edema, especially in the morning; Decreased urine output; Headache and malaise… |
| Workup / key labs | Definitive diagnosis requires kidney biopsy showing dominant or co-dominant mesangial IgA deposition on immunofluorescence with mesangial proliferation on light microscopy. Oxford MEST-C score (mesangial hypercellularity, endocapillary, segmental sclerosis, tubular atrophy, crescents) prognosticates.; Urinalysis with microscopy —… | Clinical diagnosis: nephritic syndrome + recent strep infection + low C3 + positive streptococcal serology. Biopsy reserved for atypical presentations (persistent low C3 >8 weeks, severe AKI, RPGN features) and shows endocapillary proliferative GN with subepithelial 'humps' on EM and granular IgG/C3 on IF.; Urinalysis: hematuria with… |
| Imaging | Renal ultrasound to assess size and exclude obstruction in presence of gross hematuria | Renal ultrasound usually unnecessary; normal or mildly enlarged kidneys |
| First-line treatment | BP control with ACEi (lisinopril, ramipril) or ARB (losartan, valsartan) — first-line; titrate to maximally tolerated dose; SGLT2 inhibitor — dapagliflozin or empagliflozin — added for proteinuria reduction and renal protection (KDIGO 2024); Target proteinuria <0.5-1 g/day; BP <120/80; Lifestyle: smoking cessation, sodium restriction,… | Supportive care — most cases resolve spontaneously; Sodium and fluid restriction for volume overload; Loop diuretic — furosemide — for edema and hypertension; Antihypertensives: CCB (amlodipine) or ACEi (if renal function stable); hydralazine or nicardipine for hypertensive emergency; Antibiotics (penicillin V, amoxicillin, or… |
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