title: [Immunoglobulin A nephropaty: clinical practice guidelines].
abstract: Immunoglobulin A nephropathy (N.IgA) is the world most common glomerular disease; 15-50% of patients develop loss of renal function in 10-20 years, and the rest remission or mild proteinuria/ hematuria. The optimal treatment is uncertain. Our aim was to develop evidence-based recommendations through research in Medline, Embasse, Lilacs and Cochrane Central Register of Controlled Trials. The study-quality was independently assessed by the reviewers following the Cochrane Renal Group checklist: randomization, blinding, intention-to-treat analysis and follow-up period. Levels of evidence and grades of recommendation were assigned according to Center for Evidence-Based Medicine, Oxford. Two approaches were considered: Immunosuppressive therapy (corticosteroids, cytostatics, cyclosporine A, mycophenolate-mofetil): Level I a, grade A. -Combined suppressive therapy in adults. Corticosteroids plus cytotoxics drugs (cyclophosphamide/azathioprine): Level II b, grade B. In children with severe IgA nephropathy: Level II b, grade D. Cyclosporine and mycophenolate- mophetil: Level II b, grade C. Cyclosporine and mycophenolate-mophetil: Level ll b, grade C. -Non immunosuppressive therapy: reninangiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers (ARB), fish oil, statins, antiplatelets and tonsillectomy. ACEI and/or ARB, in patients with proteinuria ≥ 1 g: Level I a, grade A. In children with moderate proteinuria: ACEI and/or ARB with close monitoring of renal function and serum potassium level: Level II b, grade B. Antiplatelet as supportive treatment: Level I a, grade C. Fish oil in addition to ACEI or ARB in patients with mild histological lesions: Level II b, grade B (Not in children). Statins: no evidence to recommend these drugs in children. In patients > 5 years with nephrotic syndrome and hyper-cholesterolemia, use statins with close monitoring of serum creatine-kinase. There is no evidence to recommend tonsillectomy.
authors: Consejo de Glomerulopatías, Asociación Nefrológica de Buenos Aires, Argentina.
authors: Alicia
authors: A
authors: Fayad
authors: Javier
authors: J
authors: Robaina Sindin
authors: Mónica
authors: M
authors: Calvo Abeucci
authors: Hernán
authors: H
authors: Trimarchi
authors: Vanina
authors: V
authors: Vázquez
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000085962:Angiotensin-Converting Enzyme 2; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000379:methods; D019317:Evidence-Based Medicine; D005395:Fish Oils / Q000627:therapeutic use; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D009173:Mycophenolic Acid / Q000627:therapeutic use; D007703:Peptidyl-Dipeptidase A; D012084:Renin-Angiotensin System; D014068:Tonsillectomy
chemical_list: D000305:Adrenal Cortex Hormones; D000806:Angiotensin-Converting Enzyme Inhibitors; D005395:Fish Oils; D016572:Cyclosporine; D007703:Peptidyl-Dipeptidase A; C000705307:ACE2 protein, human; D000085962:Angiotensin-Converting Enzyme 2; D009173:Mycophenolic Acid