How different are the current understandings of treatments for IgA nephropathy?

Abstract

IgA nephropathy (IgAN) is a common autoimmune renal disease resulting in renal failure in patients with massive proteinuria. About 15-20 % of IgAN patients will progress to end-stage kidney disease (ESKD) within 20 years. Several risk factors for the progression of IgAN include massive proteinuria, hypertension, global sclerosis, crescent formation, and tubulointerstitial fibrosis. Worldwide, therapeutic options are limited, but include nonspecific treatments to reduce proteinuria through renin-angiotensin system inhibitors (RAS-I). Another strategy, used to control chronic inflammation, includes tonsillectomy and the use of immunosuppressive agents such as corticosteroids and mycophenolate mofetil. A paucity of high-quality clinical trials has meant that the evaluation of immunosuppressive therapies has been difficult and there remains a great deal of confusion over the optimum treatment of patients with IgAN. Therefore, physicians have been left to manage patients with generic therapies, mainly by control of blood pressure and renin-angiotensin blockade. There are currently controversies on the definition and treatment of progressive IgAN. Here is the review about the evidence for existing treatment choices and the differences in current understanding of treatments of IgAN worldwide.