IgA glomerulonephritis: beyond angiotensin-converting enzyme inhibitors.
IgA glomerulonephritis accounts for 25-50% of renal biopsy diagnoses. About 25-50% of patients progress to end-stage renal disease within 20 years of diagnosis. Angiotensin-converting enzyme inhibitors and angiotensin II type I receptor blockers slow progression of IgA nephropathy (IgAN); however, as drugs of this class are not IgAN specific and are therefore unlikely to alter significantly its natural course, many other therapeutic approaches have been proposed. Most have been tested in a relatively small number of patients and have not yet proven to be effective in the long term. Conflicting and variable data, and a lack of long-term prospective randomized studies, mean that most treatments cannot be recommended as standard therapy for IgAN. Steroids seem to be the best treatment for patients with proteinuria, as drugs in this class ameliorate this symptom and protect against deterioration of renal function. Combined treatment with corticosteroids and cytotoxic drugs has yielded interesting results in several studies, especially in progressive patients with severe IgAN. In this review, we critically analyze the data on these treatments.
Locatelli
Francesco
F
Department of Nephrology and Dialysis, Ospedale A Manzoni, Via dell'Eremo, 23900 Lecco, Italy. nefrologia@ospedale.lecco.it
Vecchio
Lucia Del
LD
Pozzi
Claudio
C
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004176:Dipyridamole / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005395:Fish Oils / Q000627:therapeutic use; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011507:Proteinuria / Q000453:epidemiology; D014068:Tonsillectomy; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D005395:Fish Oils; D005938:Glucocorticoids; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole