WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Yousif Mohammed Hasan*, Dr. Safa Ezzedin Almukhtar (Professor)

ABSTRACT

Background: IgA nephropathy (IgAN) is a leading primary glomerulopathy in young and middle-aged adults, but multicenter data from Northern Iraq are scarce. We aimed to describe the biopsy yield and clinical presentation of IgAN across three regional centers to inform earlier detection and standardized care. Methods: We performed a retrospective multicenter study of all native kidney biopsies from January 2020 to June 2025 at three centers in Northern Iraq (Erbil, Sulaymaniyah, Duhok). IgAN was defined by compatible light microscopy with dominant or co-dominant mesangial IgA on immunofluorescence; transplant biopsies and cases without immunofluorescence were excluded. Demographics and presentation variables abstracted at diagnosis included age, sex, body mass index (BMI), blood pressure status, edema, urinary findings (microscopic hematuria, recurrent gross hematuria, isolated proteinuria), and renal function category (chronic kidney disease [CKD], acute kidney injury [AKI]). Proportions are reported descriptively; the biopsy yield is presented with a Wilson 95% confidence interval (CI). Results: Among 2,119 native kidney biopsies, 127 were IgAN, yielding 6.0% (95% CI, 5.1–7.1%). The cohort included 68 males (53.5%) and 59 females (46.5%), aged 15–56 years. Mean BMI was 26 kg/m² (range 20–33). At presentation, microscopic hematuria with or without proteinuria was most frequent (≈50–60%); recurrent gross hematuria occurred in ≈20% and isolated proteinuria in ≈10%. Hypertension was documented in ~50% and peripheral edema in ~20–30%. CKD was present at diagnosis in ~15%, whereas AKI was uncommon (<5%). Obese patients (BMI ≥30 kg/m²) were observed to have higher rates of hypertension and greater proteinuria at presentation. All diagnoses were confirmed by light microscopy and immunofluorescence. Conclusion: Across three centers in Northern Iraq, IgAN accounted for 6% of biopsied native kidney disease and predominantly presented with hematuria and substantial early hemodynamic burden; a notable minority had CKD at diagnosis, while AKI was rare. These findings underscore the need for systematic urinalysis screening in young adults, prompt initiation of renoprotective therapy with tight blood pressure control, and integration of cardiometabolic management, alongside efforts to standardize regional pathways and establish a prospective registry for risk stratification and outcome tracking.