title: A treatment dilemma in adult immunoglobulin A nephropathy: what is the appropriate target, preservation of kidney function or induction of clinical remission?
abstract: Immunoglobulin (Ig) A nephropathy is the most common type of glomerulonephritis worldwide. Data on its natural history suggest that approximately 40% of patients progress to end-stage renal failure after 20 years. Various therapies such as antiplatelet medication, fish oil, oral prednisolone, intravenous prednisolone, tonsillectomy, and tonsillectomy plus steroid pulse (TSP) have been proposed. Japanese nephrologists face challenging issues regarding this disease, such as the usefulness of the annual urinary screening system (kenshin) and kidney biopsies, the desire of patients and their families for treatment despite insufficient clinical evidence, and the risk of overtreatment with TSP versus the loss of a 'golden period' with late intervention. We review the current literature on tonsillectomy, steroid therapy, and TSP, which was first proposed in Japan, and present some perspectives on the treatment of IgA nephropathy.
authors.affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute-cho, Aichi, 480-1195, Japan. imaihiro@aichi-med-u.ac.jp
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Imai
authors.forename: Naoto
authors.initials: N
authors.lastname: Miura
mesh_terms: D000328:Adult; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007564:Japan; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology; D020551:Pulse Therapy, Drug; D012074:Remission Induction; D051437:Renal Insufficiency; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D014068:Tonsillectomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D013256:Steroids
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