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[IgA nephropathy].

Evangéline Pillebout1, Jérôme Vérine2

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IgA nephropathy, a leading cause of kidney failure, is an immune complex disease. Recent advances clarify its pathogenesis, but treatment guidelines remain debated, especially regarding corticosteroid use.

Keywords:
Bloqueurs du système rénine-angiotensineChronic kidney diseaseDépôts mésangiauxGlomérulonéphriteHematuriaHématurieIgAInsuffisance rénale chroniqueNephropathyNéphropathiePrimary glomerulonephritisRenine-angiotensin-aldosterone blockers

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Area of Science:

  • Nephrology
  • Immunology
  • Genetics

Background:

  • Immunoglobulin A (IgA) nephropathy is the most prevalent primary glomerulonephritis globally, contributing significantly to chronic kidney disease and end-stage renal failure.
  • While recognized as an immune complex disease, its pathophysiology is not fully elucidated, though genetic factors and a multi-hit model offer recent insights.
  • Clinical and histological presentations are highly variable, complicating classification and treatment strategies.

Purpose of the Study:

  • To review the current understanding of IgA nephropathy pathophysiology.
  • To discuss recent advancements in classification and therapeutic approaches.
  • To evaluate the controversial aspects of current treatment guidelines, including corticosteroid therapy and the role of renin-angiotensin system blockers.

Main Methods:

  • Literature review of recent studies on IgA nephropathy.
  • Analysis of genetic susceptibility loci and the multi-hit pathogenesis model.
  • Evaluation of current and proposed clinical classification systems, including the Oxford classification.
  • Assessment of treatment guidelines, focusing on the KDIGO consensus and recent clinical trial data.

Main Results:

  • Progress has been made in identifying genetic factors and understanding the multi-hit pathogenesis model of IgA nephropathy.
  • The Oxford classification aims to improve histological stratification for therapeutic studies.
  • Consensus exists for treating minimal change disease and rapidly progressive renal failure, but other management strategies, particularly corticosteroid use for proteinuria >1 g/day without renal failure, remain debated.
  • Renin-angiotensin system blockers are recommended for all IgA nephropathy patients with hypertension or proteinuria.

Conclusions:

  • IgA nephropathy management requires a comprehensive approach, integrating recentPathophysiological insights with evolving clinical and histological classifications.
  • Therapeutic decisions, especially concerning corticosteroids, necessitate careful consideration of individual patient factors and ongoing clinical evidence.
  • Standardized management of chronic glomerular disease, including blockade of the renin-angiotensin system, is crucial for all affected patients.