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IgA glomerulonephritis: beyond angiotensin-converting enzyme inhibitors

Abstract

IgA glomerulonephritis accounts for 25–50% of renal biopsy diagnoses. About 25–50% of patients progress to end-stage renal disease within 20 years of diagnosis. Angiotensin-converting enzyme inhibitors and angiotensin II type I receptor blockers slow progression of IgA nephropathy (IgAN); however, as drugs of this class are not IgAN specific and are therefore unlikely to alter significantly its natural course, many other therapeutic approaches have been proposed. Most have been tested in a relatively small number of patients and have not yet proven to be effective in the long term. Conflicting and variable data, and a lack of long-term prospective randomized studies, mean that most treatments cannot be recommended as standard therapy for IgAN. Steroids seem to be the best treatment for patients with proteinuria, as drugs in this class ameliorate this symptom and protect against deterioration of renal function. Combined treatment with corticosteroids and cytotoxic drugs has yielded interesting results in several studies, especially in progressive patients with severe IgAN. In this review, we critically analyze the data on these treatments.

Key Points

  • Incomplete understanding of the pathogenesis of IgA nephropathy has hampered development of targeted therapies

  • Angiotensin-converting enzyme inhibitors and angiotensin II type I receptor blockers slow progression of IgA nephropathy to end-stage renal disease

  • Low-antigen diets, sodium cromoglicate, phenytoin, danazol and high-dose immunoglobulins have been superseded by more effective interventions

  • Tonsillectomy, fish oil, corticosteroids and cytotoxic drugs are currently the most promising treatments

  • No treatment can be unequivocally recommended until large randomized, controlled trials are performed

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Correspondence to Francesco Locatelli.

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Mayo Nephrology Collaborative Group

The International IgA Nephropathy Network

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Locatelli, F., Vecchio, L. & Pozzi, C. IgA glomerulonephritis: beyond angiotensin-converting enzyme inhibitors. Nat Rev Nephrol 2, 24–31 (2006). https://doi.org/10.1038/ncpneph0055

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