ICD-10: N02.B

Recurrent and persistent immunoglobulin A nephropathy (IgAN), classified under ICD-10 code N02.B, is a kidney disorder characterized by the deposition of immunoglobulin A (IgA) in the glomeruli, which are the filtering units of the kidneys. Here are the clinical details and descriptions associated with this condition:

Clinical Description

• Epidemiology: IgAN is relatively rare in children under the age of 10-12 years. It is more commonly diagnosed in adolescents and young adults, although it can occur at any age [3].
• Symptoms: The clinical course of IgAN is often oligosymptomatic, meaning that it may present with few or mild symptoms. Common manifestations include:
• Microscopic Hematuria: This is the presence of blood in the urine that is not visible to the naked eye but can be detected under a microscope.
• Recurrent Gross Hematuria: In children, a notable presentation is recurrent episodes of visible blood in the urine, often triggered by upper respiratory tract infections in about half of the cases [7].
• Proteinuria: The presence of excess protein in the urine can also occur, which may indicate kidney damage.

Diagnosis and Classification

• ICD-10 Code: The specific code for recurrent and persistent IgAN with glomerular lesion is N02.B1, while N02.B encompasses the broader category of recurrent and persistent IgAN [2][5].
• Clinical Features: The diagnosis is typically confirmed through laboratory tests that reveal hematuria and proteinuria, along with kidney biopsy findings that show IgA deposition in the glomeruli.

Prognosis and Outcomes

• Kidney Function: The long-term outcomes for patients with IgAN can vary significantly. Some individuals may experience a progressive decline in kidney function, leading to chronic kidney disease, while others may have stable kidney function for many years [8].

In summary, recurrent and persistent immunoglobulin A nephropathy is a significant renal condition that requires careful monitoring and management, particularly in pediatric populations where symptoms may manifest differently. Early diagnosis and intervention can help manage the disease and improve patient outcomes.

Recurrent and persistent immunoglobulin A nephropathy (IgAN), classified under ICD-10 code N02.B, presents with a variety of clinical features and patient characteristics. Here’s a detailed overview:

Clinical Presentation

• Hematuria: The most common symptom is recurrent gross hematuria, which is often triggered by upper respiratory tract infections in approximately half of the pediatric cases [2][9].
• Asymptomatic Cases: Some patients may remain completely asymptomatic, highlighting the variability in clinical presentation [9].

Signs and Symptoms

• Variable Severity: The severity of symptoms can vary widely among patients. While some may experience significant symptoms, others may have mild or no symptoms at all [9].
• Other Symptoms: In addition to hematuria, patients may experience proteinuria, hypertension, and signs of kidney dysfunction as the disease progresses [3].

Patient Characteristics

• Demographics: IgAN can affect individuals of all ages, but it is particularly common in children and young adults. The onset often occurs in the second or third decade of life [3].
• Epidemiology: The condition is characterized by a higher prevalence in males compared to females, and it is one of the leading causes of kidney failure attributed to glomerular disease [3][4].

Summary

In summary, recurrent and persistent immunoglobulin A nephropathy is marked by recurrent hematuria, which may be asymptomatic in some cases. The clinical presentation can vary significantly, and it is essential for healthcare providers to recognize these signs and symptoms for timely diagnosis and management. The condition predominantly affects younger populations, with a notable male predominance.

The ICD-10 code N02.B refers specifically to "Recurrent and persistent immunoglobulin A nephropathy" (IgAN). Here are some alternative names and related terms associated with this condition:

• Immunoglobulin A Nephropathy (IgAN): This is the primary name for the condition, highlighting the role of immunoglobulin A in the disease process.
• Berger's Disease: This is a common alternative name for IgAN, named after the French physician Jean Berger who first described the condition.
• Recurrent Hematuria: This term is often associated with IgAN, as patients typically experience recurrent episodes of blood in the urine (hematuria) [8].
• Persistent Hematuria: Similar to recurrent hematuria, this term emphasizes the ongoing nature of the blood presence in urine, which is a hallmark symptom of the condition [8].
• Glomerular Disease: IgAN falls under the broader category of glomerular diseases, which affect the glomeruli in the kidneys [4].

These terms are important for understanding the condition and its classification within the medical community, particularly in relation to the ICD-10 coding system.

The diagnosis of Recurrent and Persistent Immunoglobulin A Nephropathy (IgAN), classified under ICD-10 code N02.B, is primarily established through a kidney biopsy. The specific criteria and findings that are used for diagnosis include:

• Mesangial Hypercellularity: This refers to an increase in the number of cells in the mesangial area of the glomeruli, which is a key indicator of IgAN.
• Matrix Expansion: This involves the thickening of the mesangial matrix, which can be observed during the biopsy.
• Endocapillary Proliferative Changes: These changes indicate an increase in the number of cells within the capillaries of the glomeruli, which is another hallmark of the disease [3].

These histopathological findings are essential for confirming a diagnosis of IgAN, as they provide direct evidence of the disease's presence in the kidney tissue.

Recurrent and persistent immunoglobulin A nephropathy (IgAN), classified under ICD10 code N02.B, has specific treatment approaches that are currently being explored. Here are the key points regarding standard treatment options:

• Renal Biopsy: The gold standard for diagnosing IgAN is a renal biopsy, which helps in confirming the condition and determining the prognosis using the Oxford classification system. This classification assesses various histological features to predict disease progression [6][9].

• Medications: Treatment options for IgAN are somewhat limited, but several approaches are commonly used:

• Corticosteroids: A delayed-release formulation of budesonide, a corticosteroid, has received accelerated approval for use in treating IgAN. This medication aims to reduce inflammation and immune response in the kidneys [7].

• Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin II Receptor Blockers (ARBs): These medications are often used in combination to manage hypertension and provide renal protection, which is crucial in patients with IgAN [4].

• Supportive Care: Alongside specific treatments, supportive care is essential. This includes managing blood pressure, monitoring kidney function, and addressing any complications that may arise from the disease.

• Research and Future Directions: Ongoing research is focused on identifying more effective treatments and understanding the underlying mechanisms of IgAN. This includes exploring new therapeutic agents that target the immune system more specifically [7].

In summary, the management of recurrent and persistent IgAN primarily involves a combination of renal biopsy for diagnosis, the use of corticosteroids, ACE inhibitors, and ARBs, along with supportive care to optimize kidney health and manage symptoms.