title: Is a legacy effect possible in IgA nephropathy?
abstract: The term 'legacy effect'--a memory of a treatment which produces benefits long after the cessation of the intervention--was adopted for the first time to describe the benefits of early and strict control of diabetes on cardiovascular complications. The search for a similar effect for early treatment of immune-mediated renal diseases, interrupting some self-amplification loops of the pathogenetical immunological mechanisms and leaving a permanent memory, is fascinating. Some recent reports suggest a long-term beneficial or legacy effect of early treatment of IgA nephropathy after a randomized controlled trial (RCT) using mycophenolate mofetil, methylprednisolone pulses or steroid/immunosuppressive multiple therapy, or prolonged steroid doses associated with tonsillectomy. Long-lasting effects of treatments are more likely to be achieved in early stages of IgA nephropathy, when mesangial proliferative or endocapillary hypercellular lesions are pre-eminent over sclerosis, and when proteinuria is not massive, above all in young patients. The long-term results considered are relevant, but have the counterpart of the risk of drug toxicity or side effects, which are particularly undesired in patients with a mild disease. Hence, there is interest for drugs targeting the intestinal mucosal immunity with a little systemic effect, aimed at interrupting the initial pathogenetical mechanism. The possibility of modulating anti-inflammatory regulatory T cells by modifying inducible enzymes is another fascinating field of future research.
authors.affiliation: Nephrology, Dialysis and Transplantation Unit, Regina Margherita Children's University Hospital, Città della Salute e della Scienza di Torino, Turin 10126, Italy. rosanna.coppo@unito.it
authors.forename: Rosanna
authors.initials: R
authors.lastname: Coppo
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005922:Glomerulonephritis, IGA / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D007156:Immunologic Memory; D007166:Immunosuppressive Agents / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents
keywords: IgA Nephropathy; Legacy Effect; Long-termRemission; Regression; Therapy