To evaluate associations between endoscopic features and hospitalization outcomes in IgA vasculitis (IgAV) with gastrointestinal (GI) involvement, focusing on endoscopic subtypes associated with prolonged hospitalization. We analyzed 132 IgAV patients with GI involvement and complete endoscopic data at a large-volume center (January 2019 to December 2024). Clinical manifestations, endoscopic characteristics, laboratory data, and abdominal imaging findings at admission were reviewed. Prolonged length of stay (LOS) was defined as LOS exceeding the 75th percentile (>13 days). Multivariable logistic regression and gamma regression (log link) were used to examine factors associated with prolonged LOS and LOS as a continuous outcome. Sensitivity analyses additionally adjusted for treatment variables and renal involvement. Laboratory parameters were compared across endoscopic subgroups in exploratory analyses. The median age of the patients was 18 years (IQR: 15.0-45.5), with a male-to-female ratio of 2:1. Abdominal pain was the most common presenting symptom. Bowel wall thickening was the most frequent finding on abdominal imaging. The most prevalent endoscopic finding was congestion/edema, followed by erosions, ulcers, and petechiae/ecchymosis. Endoscopic ulceration (OR 2.40, 95% CI 1.09-5.27, p=0.029) and multi-segment GI involvement (OR 2.58, 95% CI 1.20-5.58, p=0.016) were independently associated with prolonged LOS. Gamma regression showed that ulceration was associated with a 27.7% longer LOS (RR 1.277, 95% CI 1.047-1.564, p=0.018) and multi-segment involvement with a 34.7% longer LOS (RR 1.347, 95% CI 1.035-1.748, p=0.025). The association with ulceration remained significant after adjusting for treatment factors, whereas the association with multi-segment involvement was attenuated. The association of ulceration with LOS was more pronounced in patients aged ≤18 years. In sensitivity analyses, additional adjustment for renal involvement did not materially change the associations between endoscopic features and LOS. In IgAV with GI involvement,
IgA vasculitis (IgAV) primarily affects small vessels, but rare cases with necrotizing arteritis (NA) raise questions about overlap with polyarteritis nodosa (PAN). To characterize IgAV with necrotizing arteritis (IgAV-NA) and compare its phenotype with classical IgAV and PAN. We performed a multicenter retrospective study combined with a systematic literature review (1990-2025). Patients fulfilled EULAR/PRINTO/PRES IgAV criteria, had pathological or imaging evidence of NA in small or medium arteries, and were ANCA-negative. Thirty patients were included (7 from databases, 23 from the literature). NA was confirmed by biopsy (n = 16) or vascular imaging (n = 14). Clinical features, treatments, remission, and mortality were compared with 257 adult IgAV and 196 PAN patients. Median age was 54.5 years. IgAV-NA was characterized by severe manifestations, including gastrointestinal bleeding, perforation, surgical abdomen, neuropathy, pancreatitis, and livedo. Compared with classical IgAV, IgAV-NA showed significantly higher rates of multi-organ involvement and mortality. Compared with PAN, IgAV-NA shared vascular complications but had less fever and neuropathy. Despite arterial involvement, patients did not fulfil PAN criteria. IgAV-NA represents a rare, severe IgAV phenotype with life-threatening complications rather than an IgAV-PAN overlap. Severe or atypical IgAV presentations should prompt vascular imaging and intensified immunosuppression.
IgA nephropathy (IgAN) is a chronic kidney disease involving deposition of IgA-containing immune complexes in the glomerulus, causing glomerular inflammation and scarring. It is the most common immune-mediated glomerular disease worldwide, and affects an estimated 198 887 to 208 184 persons in the US. Up to 50% of patients with IgAN develop kidney failure within 10 years of diagnosis. IgAN typically presents with nephritic syndrome and usually occurs in younger adults, with a mean age at diagnosis of 34 to 45 years. Incidence is highest in East Asia. Approximately 60% of cases are detected incidentally with hematuria or proteinuria on urinalysis. Up to 30% of patients present with episodic visible hematuria, often concomitantly with an upper respiratory or gastrointestinal tract infection (synpharyngitic hematuria). Less common presentations include nephrotic syndrome (<5%) and rapidly progressive glomerulonephritis (<5%). When IgAN is suspected (due to hematuria, proteinuria, or reduced kidney function), initial workup should include quantification of proteinuria and assessment for other causes of nephritic syndrome (eg, lupus nephritis). Adults with suspected IgAN and proteinuria greater than or equal to 0.5 g per day should undergo kidney biopsy. The diagnosis of primary IgAN is based on presence of IgA-dominant immune deposits in the glomerular mesangium after excluding other causes of this histologic appearance, ie, IgA vasculitis, IgA-dominant infection-related glomerulonephritis, and secondary IgAN from diseases such as cirrhosis, inflammatory bowel disease, celiac disease, infection (eg, viral hepatitis), and autoimmune diseases (eg, axial spondyloarthritis). Based on the Kidney Disease: Improving Global Outcomes 2025 clinical practice guideline for the management of IgAN, treatment for patients with proteinuria greater than 0.5 g per day includes behavioral modifications (eg, dietary sodium <2 g/d, smoking cessation, weight control, exercise), antihypertensive medications for