Treatment of Immunoglobulin A Nephropathy

Abstract

IgA nephropathy (IgAN) is the most common form of glomerulonephritis throughout the world. It can slowlyprogress to chronic renal failure in 15-20% of cases during a period of 10 years after the first diagnosis. Currently,therapies for IgAN aim to slow the deterioration of kidney function and delay onset of renal replacement therapy.IgAN has a very variable course, ranging from a benign asymptomatic hematuria to a rapidly progressiveglomerulonephritis. Thus, the research should take into account the diversity of clinical manifestations, risk ofprogression and primary endpoint. This review intends to analyze previous research on treatments of IgAN, whichcould be classified into 3 subgroups: 1) Low risk IgAN, which included patients with normal kidney function andblood pressure with asymptomatic hematuria and minimal proteinuria (≤0.5 g/day), requires only supportive therapyand annual follow-up. 2) Moderate risk IgAN, include patients with renal insufficiency, hypertension or moderateproteinuria (≥0.5-1 g/d), may need steroid therapy after supportive therapy with RAS blocker unless GFR<30-50ml/min/1.73m2. 3) IgAN patients presented with nephrotic syndrome or RPGN should be treated with immunosuppressivetherapy. In conclusion, the decision on which patients to treat should be based on the prognostic factors and the riskof progression. Monitoring and supportive treatment, e.g. blood pressure management, RAS blocker should beconsidered in all patients.