Seek expert advice.
Supportive treatment, including administering angiotensin-receptor blockers (ARBs) and salt restriction, should be administered to all IgAN patients (1)
- importance of conservative therapy to reduce proteinuria and slow the rate of renal function decline in IgAN cannot be overemphasized (2)
A low protein diet is also advisable in nephrotic IgA nephropathy patients (1)
If recurrent chronic tonsillar infections then tonsillectomy is indicated
Use of immune-suppressive agents depends mainly upon the progression rate, comorbidities, and histopathological changes of the kidney biopsy (1):
- corticosteroids are currently the cornerstone of IgA nephropathy
- NICE have stated that
- Targeted-release budesonide is recommended as an option for treating primary immunoglobulin A nephropathy (IgAN) when there is a risk of rapid disease progression in adults with a urine protein-to-creatinine ratio of 1.5 g/g or more (3)
it is an add-on to optimised standard care including the highest tolerated licensed dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), unless these are contraindicated
- different therapeutic agents such as calcineurin inhibitors (CNIs), cyclophosphamide, mycophenolate mofetil, rituximab, and leflunomide (LEF) are used, but none is approved as a single or combined effective therapy for IgA nephropathy
Reference:
- Habas E, Ali E, Farfar K, Errayes M, Alfitori J, Habas E, Ghazouani H, Akbar R, Khan F, Al Dab A, Elzouki AN. IgA nephropathy pathogenesis and therapy: Review & updates. Medicine (Baltimore). 2022 Dec 2;101(48):e31219.
- Rodrigues JC, Haas M, Reich HN. IgA Nephropathy. Clin J Am Soc Nephrol. 2017 Apr 3;12(4):677-686. doi: 10.2215/CJN.07420716.
- NICE (December 2023). Targeted-release budesonide for treating primary IgA nephropathy