According to the clinical observation, there are more or less common points among IgA Nephropathy patients, such as mesangial cells proliferation, increasing mesangial matrix, glomerulosclerosis, crescent, interstitial fibrosis, renal tubule atrophy, etc. The only difference is just the severity. So, how to understand it more clearly? The main cause of most nephritis is immune complex deposition. The blood vessel in kidney is circuitous and massive, the blood amount is also more. Based on this, the immune complex circulating with blood circulation is easy to deposit here. If the amount of immune complex is temporary and in less amount , mesangial cells can remove them, so hematuria or proteinuria can disappear also. For example, many patients will have more serious hematuria and proteinuria after getting tonsillitis, but hematuria and proteinuria will become less serious after a few days. Therefore, we suggest antibiotics after patients getting infection. This is not used to treat IgA Nephropathy, but to prevent more immune complex formation so as to reduce the damage in mesangial cells.
If immune complex is in huge amount and lasts for a long time, mesangial cells can not deal with them completely. In order to face such condition, it will produce more mesangial cells to do this work and at the same time each mesangial cells is also in larger size. At this time, if biopsy is taken, more mesangial cells and broadening mesangial area can be found, and it is called mesangial cell proliferation.
However, everything should be controlled in some degree. If such condition lasts for long time, kidney will be damaged more. During mesangial cell proliferation, some other materials will be secreted at the same time. It is not easy to see clearly about their structure of these materials, but they looks like glass or coagulated cement.These materials are called mesangial matrix. And, under biopsy, it is mesangial matrix proliferation.
What's worse, with time passing, under the reaction of cell factors, mesangial will not have enough ability to remove these mesangial matrix. Besides, more mesangial matrix will also cause pressure to surrounding cells or even take the place of other health cells. Then gradually, sclerosis occurs. No matter it is glomerulosclerosis, or segmental sclerosis, it is irreversible. Therefore, during the whole treatment, preventing more glomeruli being sclerosed is the most basic and important aspect.
Crescent is formed due to the inflammation. If the inflammation due to immune complex is too active, filtration membrane will be damaged, and then some blood leak out. These blood can stimulate the epithelial cells in glomerular capsule, thus causing glomerular capsule epithelial cells proliferation. Finally, cellular crescent forms, and then cellulose crescent. Once crescent become to cellulose crescent, it is more serious, and it is difficult to reverse.
Interstitial fibrosis is just found in recent years. It can not cause hematuria or proteinuria, but it has close relationship with kidney function decline. The severity of interstitial fibrosis is an important point to estimate the prognosis of IgA Nephropathy.
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