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IgA nephropathy in adults—treatment standard

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posted on 2024-04-22, 14:30 authored by Patrick J Gleeson, Michelle M O'Shaughnessy, Jonathan Barratt

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/gfad146

Author affiliation

College of Life Sciences/Cardiovascular Sciences

Version

  • VoR (Version of Record)

Published in

Nephrology Dialysis Transplantation

Volume

38

Issue

11

Pagination

2464 - 2473

Publisher

Oxford University Press (OUP)

issn

0931-0509

eissn

1460-2385

Copyright date

2023

Available date

2024-04-22

Spatial coverage

England

Language

en

Deposited by

Professor Jonathan Barratt

Deposit date

2024-03-28

Data Access Statement

No new data were generated or analysed in support of this research.

Rights Retention Statement

  • No

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