<p>The Supportive Treatment of IgA Nephropathy and Idiopathic Nephrotic Syndrome: How Useful are Omega-3 Polyunsaturated Fatty Acids?</p>

Abstract

IgA nephropathy (IgAN) is the most prevalent glomerular disease in young adults worldwide, while idiopathic nephrotic syndrome (INS) represents the most frequent manifestation of glomerular disease in childhood. Over the years, studies have speculated about the potential benefits of omega-3 polyunsaturated fatty acids (PUFAs) in improving morbidity in both forms of chronic kidney disease (CKD). The proposed mechanisms of action include reduction of proteinuria and modulation of dyslipidemia. Although in vitro and in vivo experimental studies report the suppressive effect of omega-3 PUFAs on inflammatory pathways linked with the progression of nephropathy, the evidence supporting their beneficial effect in IgAN and INS is still weak. Also, their ability to regulate levels of total cholesterol, low-density lipoprotein-cholesterol (LDL-C), and triglycerides (TG) suggests that they could delay both dyslipidemia-associated nephrotoxicity and atherosclerosis. Most of the clinical trials that were conducted on their therapeutic benefits in IgAN patients reported positive outcomes with low and high doses of omega-3 PUFAs. However, few of the trials noted inconclusive findings, with low-quality evidence suggesting potential improvements in surrogate renal function outcomes. If the beneficial effect of omega-3 PUFAs is predicated on their hypolipidemic action, much higher doses could be used in welldesigned randomized-controlled trials (RCTs) to determine if they could produce better renal function outcomes and provide much stronger evidence of their therapeutic benefits in IgAN and INS. However, the current hypothetical mechanisms of action in these forms of CKD also include the effect of omega-3 PUFAs on renal inflammatory pathways and glomerular proteinuria. Perhaps, the unresolved therapeutic efficacy of these fatty acids in IgAN and INS suggests that their exact mechanisms of action are yet to be fully established. In this narrative review, we aim to appraise the current evidence of their potential therapeutic benefits in these diseases.

Quantitative Comparison of the Clinical Efficacy of 6 Classes Drugs for IgA Nephropathy: A Model-Based Meta-Analysis of Drugs for Clinical Treatments

“…In addition, although the efficacy of N-3 fatty acids was found to be lower in this study, it was superior to that of the placebo, especially when the proteinuria at the baseline was higher. N-3 fatty acids act on the renal inflammatory pathway to affect the level of glomerular proteinuria and regulate cholesterol and triglycerides to delay renal toxicity associated with dyslipidemia ( 26 ). Considering that N-3 fatty acids are essential fatty acids for the human body, long-term use of N-3 fatty acids is safer than other drugs; thus, it also has a certain value for treating IgA nephropathy.…”

The Therapeutic Strategies for Uremic Toxins Control in Chronic Kidney Disease

“…EPA competes with arachidonic acid to switch the synthesis pathway to promote the production of anti-inflammatory eicosanoids [77]. In addition, eicosanoids derived from O3FA have shown clinical benefits for cardiovascular disease, diabetes, and nephropathies due to their anti-inflammatory effects [77,78].…”

Omega-3 fatty acids for uremic pruritus: A meta-analysis of randomized controlled trials

“…O3FA is the critical component of cell membranes and plays a vital role in eicosanoid biosynthesis, cell signaling cascades, and gene expression. Besides, eicosanoids derived from O3FA show clinical benefits on cardiovascular disease, diabetes, cancer[ 19 20 ], nephropathies[ 21 ], and certain skin disease[ 22 ] because of their anti-inflammatory effects. Oral supplementation of O3FA has shown the benefit of relieving pruritus in atopic eczema (AD) patients[ 23 ].…”