Intraglomerular Inflammation as a Guide for Mycophenolate Mofetil-Based Treatment in IgA Nephropathy

Area of Science:

• Nephrology
• Immunology
• Pharmacology

Background:

• IgA nephropathy (IgAN) is the most common primary glomerulonephritis globally, potentially leading to end-stage kidney disease (ESKD).
• Current treatment strategies for IgAN are evolving, with limited access to newly approved therapies, necessitating evaluation of established options like mycophenolate mofetil (MMF).

Purpose of the Study:

• To critically assess the efficacy of MMF, alone or with corticosteroids, for IgAN treatment.
• To evaluate MMF's role based on the KDIGO 2024 Draft Guidelines, considering histological factors and population differences.

Main Methods:

• Systematic review of seven major clinical studies (five RCTs, two observational studies) on MMF in IgAN.
• Analysis focused on histological activity using the Oxford classification to correlate with prognosis and treatment response.

Main Results:

• MMF demonstrated significant benefits in Chinese cohorts, including reduced proteinuria, delayed ESKD progression, and improved renal outcomes, particularly in early-stage IgAN with active lesions.
• Western studies showed less consistent benefits, possibly due to differences in disease characteristics and genetics.
• MMF efficacy is linked to early initiation and presence of intraglomerular inflammation.

Conclusions:

• MMF is a viable steroid-sparing option for selected IgAN patients, especially those with active inflammation and limited access to novel agents.
• Treatment decisions for IgAN should be individualized, considering population-specific and pathology-based differences.
• Further research is needed to refine the therapeutic role of MMF in IgAN management.