Why, when and how should immunosuppressive therapy considered in patients with immunoglobulin A nephropathy?

摘要: IgA Nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. Lifelong mesangial deposition of IgA1 complexes subsist inflammation and nephron loss but complex pathogenesis in detail remains still unclear. In regard to heterogeneous course, classical immunosuppressive specific therapeutic regimes adapted renal function will here discussed addition essential supportive therapy. Renal therapy alleviates secondary, surrogate effects or sequelae on proteinuria high intraglomerular pressure subsequent nephrosclerosis by inhibition renin angiotensin system (RAASB). patients with physiological (ΔGFR  1 g/day after RAASB), corticosteroids have shown a reduction might protect further function. progressive (ΔGFR > 3 ml/min within 3 months) rapidly course without crescents biopsy, cyclophosphamide dose as induction azathioprine maintenance proven effective one randomized controlled study homogeneous cohort (ΔGFR). Mycophenolic acid provided non trials. Differentiated, precise, larger, randomized, placebo studies focused forms IgAN are lacking. Prospectively, less toxic agents be necessary treatment IgAN. This article protected copyright. All rights reserved.