13) IgA腎症

IgA nephropathy

IgA腎症は学校検尿や職場健診などでチャンス蛋白尿・血尿として発見されることが多い．診断は腎生検による病理診断が必須である．慢性進行性の経過をとり透析へ移行する例も少なくないため，わが国でも透析導入リスクの層別化を図るための重症度分類が改訂され，重症度に応じた治療介入が必要である．近年，ステロイドパルス療法，扁桃腺摘出術により寛解例が増える一方，治療抵抗例に対する治療戦略も課題である．

IgA nephropathy (IgAN) is the most common primary glomerulonephritis.　The clinical course of IgAN is extremely variable and ranges from asymptomatic microhematuria to rapidly progressive renal failure.　The diagnosis of IgAN is established only by kidney biopsy.　Long term observation has revealed that approximately 40% of IgAN patients might possibly progress to end stage renal disease (ESRD).　The Research Group of Progressive Glomerular Disease, Ministry of Health, Labor, and Welfare (MHLW) of Japan has newly stratified the severity of the disease in order to be able to predict ESRD.　Recently, tonsillectomy plus pulse steroid therapy have resulted in clinical remission with favolable long term efficacy.