[Therapy in IgA nephropathy--when and how to do it].

Area of Science:

• Nephrology
• Immunology
• Glomerular diseases

Background:

• Immunoglobulin A (IgA) nephropathy is the leading cause of primary glomerulonephritis globally.
• Clinical manifestations range from asymptomatic urinary abnormalities to severe renal insufficiency.
• Current treatment strategies are primarily based on expert consensus due to a scarcity of randomized controlled trials.

Purpose of the Study:

• To review and discuss therapeutic options for IgA nephropathy.
• To outline optimized renoprotective strategies tailored to diverse clinical presentations.
• To address the management of IgA nephropathy based on current evidence and expert opinion.

Main Methods:

• Literature review of existing randomized controlled trials and expert guidelines.
• Discussion of therapeutic approaches for different clinical phenotypes of IgA nephropathy.
• Synthesis of evidence for optimized renoprotective treatment.

Main Results:

• Limited high-quality evidence from randomized controlled trials exists for IgA nephropathy treatments.
• Treatment decisions often rely on expert opinion and extrapolation from other glomerulonephritides.
• A spectrum of therapeutic interventions is considered, targeting underlying mechanisms and clinical severity.

Conclusions:

• Optimized management of IgA nephropathy requires addressing IgA1 glycosylation defects and mesangial deposition.
• Tailored therapeutic strategies are essential for different clinical presentations.
• Further high-quality research, including randomized controlled trials, is needed to establish definitive treatment guidelines.