Controversial Management Strategies for IgA Nephropathy

Abstract

When Professor Jean Berger et al . first reported on“Nephropathy with mesangial IgA-IgG deposits,” namely, IgA nephropathy, in 1968, the prognosis of this disease was generally considered to be benign 1) . Since then, however, patients with IgA nephropathy have been shown to have microscopic and macroscopic hematuria and/or proteinuria. Macroscopic hematuria is occasionally observed after upper respiratory infections, including acute tonsillitis and/or pharyngitis. The occurrence of nephrotic syndrome is rare. About 30％ of IgA nephropathy patients develop end stage kidney disease (ESKD) within 15-20 years, and 5-10％ within 5 years, in Japan. The progression to ESKD in patients with this disease is not as rare as originally thought. Basically, a low-salt diet is usually recommended to control blood pressure, as high salt intake is a major cause of blood pressure increases. Long-term dietary protein restriction is generally considered to reduce the levels of urinary protein excretion and ameliorate glomerular injuries in patients with IgA nephropathy. There are many reports, such as those regarding kidney disease with improving global outcomes (KDIGO) and those from the Japanese guidelines, with respect to medications for IgA nephropathy patients 2)3) . KDIGO clinical practice guidelines were published in Kidney International in 2012 2) . Within each recommendation, the strength of recommendation is indicated as Level 1, Level 2, or not graded, and the quality of the support is shown as A, B, C, or D. In this plenary session, I would like to review controversial management strategies for IgA nephropathy patients using several drugs.