From the Guidelines
IgA nephropathy is a kidney disease characterized by the deposition of immunoglobulin A (IgA) in the glomeruli, leading to inflammation and potential kidney damage over time, with treatment focusing on optimized supportive care, including RAS blockade, blood pressure control, and lifestyle modifications. The primary goal of treatment is to reduce proteinuria and slow kidney function decline, with the International IgAN Prediction Tool available to assess disease prognosis 1.
Key Treatment Considerations
- Optimized supportive care is the primary focus of IgAN management, including RAS blockade with ACE inhibitors or ARBs, such as lisinopril 10-40mg daily or losartan 50-100mg daily, to reduce proteinuria and slow kidney function decline 1.
- For patients with significant proteinuria (>1g/day) despite optimal blood pressure control, corticosteroids may be considered, such as prednisone 0.5mg/kg/day for 6 months with gradual tapering, but with caution due to potential adverse effects 1.
- Lifestyle modifications are essential, including salt restriction (<2g sodium daily), moderate protein intake (0.8g/kg/day), regular exercise, smoking cessation, and maintaining healthy weight 1.
- Regular monitoring of kidney function, proteinuria, and blood pressure is crucial, with follow-up every 3-6 months depending on disease activity 1.
Recent Developments and Considerations
- The use of targeted-release glucocorticoid, budesonide, has shown potential in reducing proteinuria with minimal adverse effects, and has been granted accelerated approval by the FDA for primary IgA nephropathy with a UPCR > 1.5 g/g 1.
- Immunosuppressive therapies, such as cyclophosphamide or mycophenolate mofetil, may be considered in severe cases with rapidly declining kidney function, but under specialist supervision and with careful consideration of potential risks and benefits 1.
From the Research
Definition and Overview of IgA Nephropathy
- IgA nephropathy (IgAN) is a type of primary glomerulonephritis characterized by the deposition of IgA antibodies in the glomeruli, leading to inflammation and damage to the kidneys 2, 3, 4.
- It is one of the most common forms of primary glomerulonephritis globally, with a significant lifetime risk for kidney failure and socioeconomic burden 4.
Clinical Presentation and Diagnosis
- IgAN can present with a range of symptoms, including macro-microscopic hematuria, proteinuria, and arterial hypertension 2.
- Diagnosis is typically made through renal biopsy, which shows the presence of IgA deposits in the glomeruli 2, 5.
Treatment and Management
- Treatment of IgAN is multifaceted and depends on the severity of the disease and the presence of other clinical conditions 2, 3, 4.
- The use of renin-angiotensin system blockers (RASB), such as ACE inhibitors and angiotensin II receptor blockers (ARBs), is a common approach to reduce proteinuria and slow disease progression 2, 3, 5, 6.
- Combination therapy with RASB and other agents, such as polyunsaturated fatty acids (PUFA) or immunosuppressants, may also be effective in reducing proteinuria and preserving kidney function 3, 5, 6.
- New therapies, including sodium-glucose transporter-2 inhibitors and complement factor B inhibitors, are being evaluated and may offer additional treatment options for patients with IgAN 4.