The treatment of IgA nephropathy: status at the end of the millenium

In the early years after the first description of IgA nephropathy, a nihilistic attitude prevailed in therapy because the initial proposals were not convincing, being both empirical and uncontrolled. The situation now seems to be changing. Although the pathogenesis of IgA nephropathy is still not fully understood, a number of drugs--supposed to interfere with some disease mechanisms--have been tested with proper study design. As a consequence, the current therapeutic approach to IgA nephropathy is based on the results of large controlled trials of glucocorticoids, immunosuppressors, anticoagulants, ACE-inhibitors, fish oil, etc., provided that the patients are selected among those with a greater risk for progression. This therapeutic approach, though still empirical, is the mainstay at present. As we approach the new millennium, we are getting tantalizingly closer to understanding the pathogenesis of IgA nephropathy and to develop new effective drugs.