The Treatment of IgA Nephropathy

Abstract

Background: IgA nephropathy (IgAN) is a very common glomerulonephritis worldwide. Nevertheless, treatment options for primary IgAN are still largely based on opinion or weak evidence. There is a lack of large randomized controlled trials (RCT) that provide a definitive immunosuppressive protocol for IgAN. The recent KDIGO Clinical Practice Guidelines for Glomerulonephritis have assigned low levels of evidence for almost all recommendations and suggestions related to this nephropathy. Summary: In this article, we review different treatment options and emphasize that the key to therapeutic decision-making is the assessment of an individual's prognosis. The risk of disease progression is closely related to clinical parameters such as proteinuria, hypertension, and impaired glomerular filtration rate. For patients with minor urinary abnormalities, the mainstay of treatment is long-term regular follow-up to detect renal progression and hypertension. Optimized supportive care aiming to maintain proteinuria <1 g/day is preferred in the typical patient presenting with microhematuria, significant but nonnephrotic proteinuria, hypertension, and variable degrees of renal failure. The atypical patient with overt nephritic syndrome or rapidly progressive kidney injury that represents a vasculitic form of IgAN should be treated with immunosuppression. Finally, the variant of overlapping syndrome of IgAN and lipoid nephrosis that runs a good prognosis should be treated as lipoid nephrosis. Key Message: The treatment of IgAN should be structured according to the clinical scenario.

Effects of <i>Tripterygium wilfordii</i> Induction Therapy to IgA Nephropathy Patients with Heavy Proteinuria

“…31,32) ACEI and ARB provide marked antiproteinuric and long-term renoprotective effects in patients with IgAN. 33,34) In our study, most of the patients were commonly combined application of AECI/ARB, and this could partially account for the relatively higher remission rates than the previous reports. 31) In 1977, Leishi 7) first proposed TWHF to treat glomerulonephritis.…”

East Meets West: Harmony but Not Uniformity

“…In this issue, IgAN, the most common glomerular disease worldwide, with a higher prevalence in Asia, and DN, the leading cause of ESRD in most Western countries, have been chosen as the main topics. International experts discuss the pathogenesis, treatment and research findings from the Western and Eastern points of view [12,13]. We heard from the duets that the prevalence of IgAN is higher in Asia than in Europe and North America.…”