Treatment Of IgA Nephropathy
Immunoglobulin A nephropathy (IgAN) is the most common pattern of idiopathic glomerulonephritis in all countries where renal biopsy is widely practiced. It is an important cause of end-stage renal disease (ESRD) at all ages, and therefore treatment strategies to reduce the risk of IgAN progressing to ESRD would have substantial health benefit. There are, however, few well-designed randomized controlled trials (RCTs) to inform the treatment of this condition. The reason for this is in part the slow rate of progression of IgAN, IgA nephropathy usually doesn't cause symptoms in the early stages. The disease can go unnoticed for decades and is sometimes first suspected when routine tests reveal protein and red blood cells in your urine that can't be seen without a microscope (microscopic hematuria).
Although IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide, our understanding of the pathogenesis of this complex disease remains limited. IgA nephropathy may appear with a variety of clinical presentations, a number of different clinical and histopathologic risk factors for progressive renal disease, and a very variable course over time. Thus, it is not surprising that a single therapeutic treatment plan has not been established. Many of the studies dealing with IgAN are retrospective, lack statistical significance, or have confounding designs, which hinder their general acceptance. Nevertheless, a number of welldesigned studies have been performed. This paper reviews currently available therapeutic options for IgAN. It attempts to address several important questions: Why do we treat patients with IgAN? How do we decide which patients should be treated? What are the general treatment guidelines for all IgAN patients? What is the role of specific therapy such as fish oils, tonsillectomy, and immunosuppression in the treatment of patient with IgAN? It also addresses several on-going trials and goals for future therapeutic studies for IgAN patients.