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Immunomodulatory agents against IgA nephropathy.

Sydney C W Tang1, Joseph C K Leung, Kar Neng Lai

  • 1Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China. scwtang@hku.hk

Advances in Oto-Rhino-Laryngology
|August 26, 2011
PubMed
Summary

Immunomodulatory agents show potential for treating immunoglobulin A nephropathy (IgAN). Corticosteroids and cyclophosphamide may slow progression, but optimal therapy remains debated for IgAN patients.

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Area of Science:

  • Nephrology
  • Immunology
  • Pharmacology

Background:

  • Aberrant IgA synthesis is key in immunoglobulin A nephropathy (IgAN) pathogenesis.
  • This suggests immunomodulatory agents as a treatment strategy for IgAN.

Purpose of the Study:

  • To review the evidence for immunomodulatory agents in IgAN treatment.
  • To guide therapeutic choices for IgAN patients.

Main Methods:

  • Review of existing clinical evidence on various immunomodulatory drugs.
  • Analysis of treatment outcomes based on patient characteristics and disease severity.

Main Results:

  • Corticosteroids and cyclophosphamide show promise in reducing proteinuria and slowing IgAN progression.
  • Mycophenolate mofetil efficacy varies by ethnicity and disease stage.
  • Cyclosporine and azathioprine have limited or equivocal roles.

Conclusions:

  • Immunomodulatory therapy choice for IgAN is controversial.
  • Adjunctive therapy is recommended for proteinuria >1 g/day with optimal BP control.
  • Aggressive treatment is reserved for severe IgAN cases.