Lee’s Grading System for IgA Nephropathy

Lee’s Grading System for IgA NephropathyMany IgA Nephropathy patients do not know how far their condition has progressed after seeing the results on the test report. For example, some of the test report show "Lee’s Grading I", while others show "Lee’s Grading III". Then what is Lee’s grading system for IgA Nephropathy? Go on reading to learn more information.

(1) Grade I: Most of the glomeruli in this stage are normal, occasionally mild mesangial enlargement (segmental) with and/or without cell proliferation, while renal tubules and interstitium remain unchanged, which is the lightest type in Lee's grading.

(2) Grade II: The glomeruli show focal mesangial proliferation and sclerosis (< 50%) in this period. There are rare small crescents with no damage to renal tubules and interstitium. Compared with the first stage, the lesion in this stage is more serious. Under light microscope, it is a focal lesion. The lesion affects a few glomeruli (focal) and some lobules (segmental) of glomeruli.

(3) Grade III: At this time, the glomeruli show diffuse mesangial proliferation and enlargement (occasional focal segments), occasional small crescents; renal tubules and interstitial changes show focal interstitial edema, occasional cell infiltration, rare tubular atrophy. Inflammation can be caused by cell infiltration. If not stopped in time, renal function cells will undergo phenotypic transformation and release a series of nephrotoxic factors in the process of inflammation. The area of glomerulosclerosis will increase, tubular atrophy will increase, and renal interstitial vascular fibrosis will also occur.

(4) Grade IV: Glomerular lesions show severe diffuse mesangial hyperplasia and sclerosis, some or all glomerular sclerosis, crescents < 45%. Renal tubular atrophy, interstitial infiltration of kidney, occasionally renal interstitial foam cells. Take the crescent as an example: this type of crescent is close to 50%. It can be said that if patients do not pay attention to it, they will probably reach this figure. Studies show that when the crescents exceed 50% of the total glomeruli, it is crescent glomerulonephritis (or crescent IgA Nephropathy), which is the most common type II-immune complex crescent nephritis besides lupus nephritis in China. The severity of inflammation is self-evident.

(5) Grade V: The nature of glomerular lesions is similar to Grade IV, but more serious. Glomerular crescent formation is more than 45%. Renal tubular and interstitial lesions are similar to Grade IV, but more serious. This stage of IgA nephropathy is the most serious of IgA nephropathy, so treatment is also the most difficult. The treatment of IgA nephropathy is no different from grade IV treatment, but requires more stringent treatment, perhaps in the treatment of a relatively long time.

At grade I, the clinical symptoms of patients are relatively insignificant, so it is easy to despise the condition and not give active treatment.

When the symptoms are obvious, the results are grade II, III or even IV, V. At this time, the disease is becoming more and more difficult to treat, so the treatment of IgA nephropathy in this stage is mainly a positive attitude of patients.

By grade II, the principle of treatment is to stop the speed of glomerulosclerosis, which prevents the progression of the disease.

The treatment of IgA nephropathy in grade III is more difficult than that in type II. Preventing the phenotype transformation of healthy cells becomes one of the key points in the treatment of IgA nephropathy. Only by preventing the phenotype transformation of cells in time can the release of nephrotoxic factors be reduced and the effect on healthy kidney tissue be reduced.

In grade IV, renal tubular atrophy and renal interstitial infiltration will directly lead to a large number of toxins not to be discharged from body, resulting in hypertension, serious electrolyte disorders, oliguria and even anuria, which is equivalent to the clinical period of uremia, and ultimately patients can only rely on dialysis. It can be said that IgA nephropathy treatment has entered a very difficult period at this time, but if the treatment is appropriate, dialysis frequency can be prolonged or even stopped. If patients can actively seek treatment in this period, the quality of life is still guaranteed, so patients must not lose hope.

The pathological changes in grade V are the most serious in IgA nephropathy, so it is the most difficult to treat. The treatment of IgA nephropathy is similar to that of grade IV IgA nephropathy, but more stringent treatment is needed. Perhaps the treatment time will be relatively long.

Therefore, we have always advocated early detection and early control of IgA nephropathy treatment. The most important thing to achieve this is the active cooperation of patients, so patients must attach great importance to their own disease in order to block the process of renal fibrosis in the early stage.


***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***

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