[Advances in primary glomerular disease in 2007]

The most relevant articles published in the field of glomerular disease in 2008 are reviewed in this study. They mostly deal with membranous nephropathy and IgA nephropathy. Regarding treatment of membranous nephropathy presenting with nephrotic syndrome and normal renal function, the good remission rates and excellent long-term renal survival of cyclophosphamide and prednisone are confirmed. Cyclosporine A and tacrolimus are less aggressive options. Cyclosporine A was shown to be an effective alterative compared to alkylating agent and prednisone, whereas tacrolimus emerged as a solid alternative. Both share few side effects and high relapse rates. In cases of membranous nephropathy presenting with nephrotic syndrome and incipient renal failure, mycophenolate mofetil has a response rate comparable to cyclophosphamide and prednisone, but with a higher relapse rate. With regard to IgA nephropathy, the prognostic importance of histology and proteinuria was confirmed. Thus, the risk of progression can be well stratified by subdivision of Lee's classification from 5 to 3 classes. Proteinuria is another very important risk factor for progression and its reduction (partial remission) improves the prognosis. Over this last year, advances have been published in the field of noninvasive diagnosis of this entity and in this regard sub-galactosidate IgA levels are important. Regarding treatment, ACEIs (benazepril) have been shown to improve the prognosis in IgA nephropathy with proteinuria between 1-3 g/day.