Expanding options of supportive care in IgA nephropathy

Abstract

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide, with a potentially serious prognosis. At present, management of IgAN is primarily based on therapeutic lifestyle changes, and excellent blood pressure control and maximized supportive treatment with the combination of inhibition of the renin–angiotensin–aldosterone system with either inhibitors of angiotensin-converting enzyme or angiotensin II receptor blockers and inhibitors of sodium-glucose cotransporter-2, and possibly in the future also with endothelin antagonists. Supportive care currently represents the cornerstone of treatment of IgAN. Targeted-release formulation of budesonide should replace systemic corticosteroids in patients with higher proteinuria and active histological lesions. New treatment options are aimed at immunopathogenesis of IgAN including depletion or modulation of Galactose-deficient-Immunoglobulin A1–producing B cells, plasma cells, and the alternate and/or lectin pathway of complement. The exact place of monoclonal antibodies and complement inhibitors will need to be determined. This article reviews potential supportive therapies currently available for patients with IgAN.

Circulating Proteins and IgA Nephropathy

“…3 In recent years, attention has been given to potential novel medicines such as inhibitors of sodium-glucose cotransporter 2 inhibitors, sparsentan (an oral, dual endothelin angiotensin receptor antagonist), budesonide (an oral, targeted-release capsule formulation of budesonide), and, possibly in the future, also with complement-targeted therapy. [4][5][6] Despite the increasing number of new potential options, immunosuppressive therapies such as systemic corticosteroids, cyclophosphamide, and mycophenolate remain to be commonly used, particularly for patients at high risk of kidney function decline. 7 Because of their ambiguous effectiveness and undesirable side effects, these approaches have been controversial.…”