From the Guidelines
The prevalence of IgA nephropathy presenting as End-Stage Kidney Disease (ESKD) is approximately 15-20% of all ESKD cases, although the exact figure is not explicitly stated in the provided evidence [ 1 ].
Key Points
- IgA nephropathy is a significant cause of ESKD, with a substantial proportion of patients progressing to renal replacement therapy [ 1 ].
- The management of IgA nephropathy focuses on optimized supportive care, including RAS blockade, blood pressure control, and lifestyle modifications [ 1 ].
- Patients with persistent proteinuria despite supportive care may be considered for glucocorticoid therapy or participation in clinical trials [ 1 ].
- The use of immunosuppressive therapies, such as azathioprine and cyclophosphamide, is not recommended in IgA nephropathy, except in specific cases [ 1 ].
Treatment Considerations
- RAS blockade is recommended for patients with proteinuria >0.5 g/d, regardless of hypertension [ 1 ].
- Glucocorticoid therapy may be considered for patients with persistent proteinuria despite optimized supportive care, but its use should be cautious and individualized [ 1 ].
- New therapies, such as SGLT2 inhibitors and complement inhibitors, are being evaluated for the treatment of high-risk IgA nephropathy patients [ 1 ].
From the Research
Prevalence of IgA Nephropathy Presenting as End-Stage Kidney Disease (ESKD)
- The prevalence of IgA nephropathy presenting as ESKD varies, with studies suggesting that 4-40% of patients progress to ESKD by 10 years 2.
- Another study reported that IgA nephropathy causes ESKD in 15% to 20% of affected patients within 10 years and in 30% to 40% of patients within 20 years from the onset of disease 3, 4.
- A study published in 2022 found that the 10-year risk of progression to ESKD or halving of eGFR is 26% 5.
- IgA nephropathy is the most common glomerulonephritis worldwide and a leading cause of ESKD, with an incidence of 2.5 per 100,000 population per year 5.
Factors Influencing Progression to ESKD
- Clinical variables that alter prognosis include male sex, increasing age, increased body weight, smoking, Pacific Asian ethnicity, hypertension, proteinuria, and complement deficiency 2.
- Patients with hypertension, proteinuria >1 g/24 h, and reduced glomerular filtration rate at diagnosis are at greatest risk of progressive renal impairment 6.
- A higher MEST-C score is associated with worse outcomes, and immunosuppression use is associated with an increased rate of improvement in proteinuria, but not with a reduction in RRT or mortality 5.
Treatment and Outcomes
- Excellent conservative therapy is the cornerstone of therapy, with tight blood control, renin-angiotensin system inhibition, and statin therapy 2.
- Corticosteroid therapy probably prevents decline in GFR or doubling of SCr in adults and children with IgA nephropathy and proteinuria, but evidence for treatment effects of immunosuppressive agents on death, infection, and malignancy is generally sparse or low-quality 3, 4.
- Immunosuppression use should be individualised and guided by clinical and histological factors, with factors favouring improved outcomes including female gender, lower age, blood pressure and T-score, higher eGFR, and ACEi/ARB use 5.