In Reply.—The patient report by Cachero et al illustrates two interesting points about the development of end-stage renal disease in IgA nephropathy. First, it points out the important negative prognostic significance of hypertension and heavy proteinuria. As Cachero et al mention, this observation has been made in other series of patients. Although recurrent gross hematuria is often regarded as the hallmark of IgA nephropathy, the disease may occur in the total absence of hematuria.
This patient report also demonstrates that end-stage renal disease can evolve in IgA nephropathy in the absence of crescents. Patients such as the five we described, with crescenteric nephritis and rapid deterioration, are probably not typical. The child described by Cachero et al, in whom there was about a five-year course before end-stage renal disease occurred, probably represents a more usual situation. This is the type of natural history described by Droz,1 in whose
WELCH TR, BERRY A, McADAMS AJ. A Patient with IgA Nephropathy-Reply. Am J Dis Child. 1989;143(2):138–139. doi:10.1001/archpedi.1989.02150140020007