Management of IgA nephropathy: Evidence-based recommendations

Abstract

Management ofIgA nephropathy: Evidence-based recommenglomerular diseases, whereas in Europe, it has been redations. The condition known as IgA nephropathy was first ported in 10 to 30% of glomerular disease series [8]. In identified when Berger observed mesangial staining for IgA in the United States, the overall prevalence is approxihealthy patients with isolated hematuria. These patients often mately 10 to 15% [9], although in specific groups such presented with recurrent synpharyngitic hematuria or less freas the American Indians in the Southwest, the rate is quently with asymptomatic microscopic hematuria and proteinuria. Although initially considered benign, we now recognize 35% [10]. IgAN is uncommon in blacks, whether they it as a common cause of end-stage renal failure. The overall live in the United States or in Africa [11, 12]. prognosis may be better than suggested in the literature, as Recurrence of IgAN after transplantation [13], evipatients with mild asymptomatic hematuria are often not biopdence showing that IgA glomerular deposits disappear in sied and, therefore, frequently are not included in published a kidney from an IgA donor [14], and IgA deposits obarticles. We reviewed prospective and retrospective adult studies published after 1976 and analyzed them to produce evidenceserved in other organs such as skin, lungs [15], or intesbased recommendations. Patients with proteinuria over 3 g/day,

Atypical triad of IgA nephropathy: reversible acute kidney injury, gross hematuria, and severe bilateral flank pain

“…Based on these prognostic factors, evidence-based treatment recommendations include prednisone for patients with more than 3 g of proteinuria per day, mild glomerular changes on biopsy, and preserved renal function (eGFR [70 mL/min) [10]. Fish oil has been recommended for those with progressive renal dysfunction (eGFR \70 mL/min) [10].…”

“…Based on these prognostic factors, evidence-based treatment recommendations include prednisone for patients with more than 3 g of proteinuria per day, mild glomerular changes on biopsy, and preserved renal function (eGFR [70 mL/min) [10]. Fish oil has been recommended for those with progressive renal dysfunction (eGFR \70 mL/min) [10]. Cyclosporine, cyclophosphamide, warfarin, and dipyridamole have generally not been recommended unless crescentic and/or rapidly progressive glomerulonephritis is detected [10].…”

“…Cyclosporine, cyclophosphamide, warfarin, and dipyridamole have generally not been recommended unless crescentic and/or rapidly progressive glomerulonephritis is detected [10]. Hypertensive patients with proteinuria should be treated with an ACE inhibitor or angiotensin receptor blocker (ARB) [10].…”

Antithrombotic Drug Therapy for IgA Nephropathy: A Meta Analysis of Randomized Controlled Trials

“…Evidence-based recommendations for the management of IgAN have been published since 1999 (25), but most evidence-based recommendations are based on immunosuppressive treatments for IgAN (26)(27)(28)(29). At present, steroids may be the most promising intervention in terms of both renal function and proteinuria (28).…”

Glomerulonephritis: is it worth worrying about?

“…3 Simple urine microscopy can reveal casts, tubular-shaped structures comprised of cell debris and/or intact cells, a sign of cell damage in the kidney and therefore suggestive of a renal cause for haematuria. If proteinuria is associated with haematuria, a renal cause is likely and initial investigation should be nephrological.…”