IgA nephropathy in adults—treatment standard
Immunoglobulin A nephropathy (IgAN) is the most common primary form of glomerular disease worldwide and carries a high lifetime risk of kidney failure. The underlying pathogenesis of IgAN has been characterized to a sub-molecular level; immune complexes containing specific O-glycoforms of IgA1 are central. Kidney biopsy remains the gold-standard diagnostic test for IgAN and histological features (i.e. MEST-C score) have also been shown to independently predict outcome. Proteinuria and blood pressure are the main modifiable risk factors for disease progression. No IgAN-specific biomarker has yet been validated for diagnosis, prognosis or tracking response to therapy. There has been a recent resurgence of investigation into IgAN treatments. Optimized supportive care with lifestyle interventions and non-immunomodulatory drugs remains the backbone of IgAN management. The menu of available reno-protective medications is rapidly expanding beyond blockade of the renin–angiotensin–aldosterone system to include sodium-glucose cotransporter 2 and endothelin type A receptor antagonism. Systemic immunosuppression can further improve kidney outcomes, although recent randomized controlled trials have raised concerns regarding infectious and metabolic toxicity from systemic corticosteroids. Studies evaluating more refined approaches to immunomodulation in IgAN are ongoing: drugs targeting the mucosal immune compartment, B-cell promoting cytokines and the complement cascade are particularly promising. We review the current standards of treatment and discuss novel developments in pathophysiology, diagnosis, outcome prediction and management of IgAN.
History
Citation
Patrick J Gleeson, Michelle M O'Shaughnessy, Jonathan Barratt, IgA nephropathy in adults—treatment standard, Nephrology Dialysis Transplantation, Volume 38, Issue 11, November 2023, Pages 2464–2473, https://doi.org/10.1093/ndt/gfad146Author affiliation
College of Life Sciences/Cardiovascular SciencesVersion
- VoR (Version of Record)
Published in
Nephrology Dialysis TransplantationVolume
38Issue
11Pagination
2464 - 2473Publisher
Oxford University Press (OUP)issn
0931-0509eissn
1460-2385Copyright date
2023Available date
2024-04-22Publisher DOI
Spatial coverage
EnglandLanguage
enPublisher version
Deposited by
Professor Jonathan BarrattDeposit date
2024-03-28Data Access Statement
No new data were generated or analysed in support of this research.Rights Retention Statement
- No