When determining the cause of blood in the urine (hematuria), your doctor looks for many things like infection or injury of the kidney or urinary tract. The urinary tract is the whole system that drains urine, including the tubes (ureters) from the kidneys, the bladder, and the outlet (urethra) from the bladder. IgA nephropathy is one of the diseases that can affect the kidneys themselves and cause hematuria.
If you doctor thinks the blood is coming from your kidneys, they may obtain the advice of a pediatric nephrologist who can help with diagnosis and treatment if needed. Disease of the kidney filters is called glomerulonephritis and it is often this group of kidney diseases that causes hematuria. "Glomerulus" is Latin for filter and "nephritis" is Greek for kidney. Because the kidneys filter (clean) your blood all the time, when they get sick, blood can leak into the urine. IgA Nephropathy is not called IgA Glomerulonephritis in typical cases because the filters are usually not as sick as in some other types of kidney disease. Instead, we use the term "nephropathy" which means "something wrong with the kidneys".
If bloody urine seems to come and go, especially at the time of colds, flu or other stress, it may be due to IgA nephropathy, but it can only be diagnosed by looking at the filters with a microscope. In order to look at the filters through a microscope, the pediatric nephrologist must perform a kidney biopsy to get a tiny piece of kidney with a needle. If a protein called Immunoglobulin A (IgA) is found when looking at the glomeruli under a microscope, then IgA Nephropathy is the problem. No one knows why this blood protein gets into glomeruli, or why it causes the glomeruli to leak blood. However, it is the most common cause of kidney inflammation around the world.
Not all kids with suspected IgA nephropathy need a biopsy, especially if the rest of the evaluation is entirely normal. Although blood in urine looks bad and can sometimes cause backaches, IgA nephropathy doesn't cause permanent damage in 85% of cases. However, symptoms can last for years. If the case is severe and kidney function is being hurt, your nephrologist has the experience and knowledge to try medicines that may help.
As in all kidney diseases, blood and urine tests are used to see how well the kidneys are working and to see if there are any abnormalities that point to more serious kidney disease. IgA nephropathy is serious if kidney function is less than normal, protein is leaking into the urine (proteinuria) and/or high blood pressure (hypertension) is present.
Medical steroids are used to treat severe cases. Medicines to treat high blood pressure are important too. Depending on how well the kidneys are working, there are other medicines used to take care of sick kidneys. The Kidney Center helps monitor the kidneys and effects of treatment. Urine and blood tests and blood pressure need to be checked on a regular basis. If things are going well, less visits are needed.