Treatment of IgA nephropathy: an overview

Abstract

Summary: The results of proposed approaches to the treatment of IgA nephropathy are discussed, stressing the difficulty of their correct evaluation due to the variable evolution of the disease. There is no convincing evidence that supports a beneficial effect for many of the therapeutical remedies with the following exceptions: (i) steroids are effective in the rare patients with selective proteinuria in the nephrotic range and very mild lesions by light microscopy (minimal change nephropathy with IgA mesangial deposits). the use of steroids is useful, in association with cyclophosphamide, even in patients with morphological features of intraglomerular capillaritis (segmental necrotizing lesions) and/or extracapillary proliferation in more than 25% of glomeruli (independently of the presence of diffuse circumferential crescents and a rapidly progressive course). A controlled trial that is underway will attempt to establish whether steroids can be effective in retarding deterioration of renal function in other subgroups of patients at risk of progression; (ii) fish‐oil, administered orally (12 g/day for 2 years), is beneficial in patients at risk of progression (marked proteinuria, moderately impaired renal function, arterial hypertension and morphological features of active disease); and (iii) long‐term administration of angiotensin converting enzyme (ACE)‐inhibitors, even in the absence of arterial hypertension, seem to slow the progression and reduce the protein loss in the same group of patients at risk.