Meta-Analysis of Randomised Controlled Trials in Patients with Primary IgA Nephropathy (Berger's Disease)

Abstract

An overview of the papers published in the last 10 years was performed to evaluate whether treatment with currently available drugs was beneficial in patients with primary IgA nephropathy (IgAN). Eight selected papers involving 196 IgAN patients with moderate or heavy proteinuria, associated in some cases with the nephrotic syndrome, were analysed. The criteria for inclusion were strict, because meta-analysis requires randomised controlled trials with full descriptions. Furthermore, papers were selected in which treatment was performed on IgAN patients with proteinuria, since prognosis is poor in the presence of this sign. The results of statistical analysis show that IgAN patients with heavy proteinuria, whether or not associated with the nephrotic syndrome, benefit from the administration of corticosteroids and/or cytotoxic drugs, as 66.7% of patients had complete or partial remission both in controlled trials and in retrospective studies; renal function also improved in treated patients. In contrast, no beneficial effect was observed in IgAN patients with moderate proteinuria. These results suggest that it is advisable to administer corticosteroids and/or cytotoxic drugs to IgAN patients with heavy proteinuria, irrespective of the association of this condition with the nephrotic syndrome in individual patients.

Steroid Treatment for Severe Childhood IgA Nephropathy

“…Corticosteroids, immunosuppressive agents, antiplatelet drugs, and anticoagulants have been used singly or in combination in children and adults with IgAN (7,(15)(16)(17)(18)(19). However, clinical trials that were conducted in the early period have not provided convincing evidence of any beneficial effect of drugs (20,21).…”

Meta-analysis of antiplatelet therapy for IgA nephropathy

“…Schena et al 26 reported that the administration of cytotoxic agents and/or steroids brought complete or partial remission to 66.7% of patients with heavy proteinuria. Nolin and Courteau 27 reviewed prospective and retrospective studies and analyzed them to produce evidence-based recommendations.…”

IgA Nephropathy in Children

“…However, clinical trials have not provided convincing data to show a beneficial effect of any drugs [106, 107]. The differences in the effects of combination therapy between our patients and adult patients may be due to differences in the duration of the disease before treatment.…”