Treatment of immunoglobulin A nephropathy

In this review, therapeutic trials for treatment of IgA nephropathy (Berger 's disease) are reviewed and discussed, No disease-specific therapy exists. For treatment of hypertensive patients, angiotensin converting enzyme (ACE ) inhibitors are preferred. They also decrease proteinuria and probably slo w disease progression. However, there are still no controlled data on the e ffectiveness of ACE-inhibitors in the absence of hypertension or proteinuri a. Renewed enthusiasm for treatment with fish Oil arose after the publicati on of a randomized controlled trial in 1994 and long-term follow-up data of the trial cohort in 1998. Corticoid therapy in IgA nephropathy has been ad vocated for patients with nephrotic syndrome or crescentic disease. A recen t non-randomised trial with long-term follow-up suggests that, in the prese nce of moderate proteinuria, corticosteroids may ameliorate renal function if administered before the creatinine clearance has decreased below 70 ml/m in. preliminary data suggest that mycophenolate mofetil (MMF) may reduce th e risk of clinically significant IgA nephropathy recurring in kidney allogr afts, Many other promising treatment approaches have been tested, but in mo st instances results are insufficient for unequivocal conclusions. Several randomized controlled clinical trials are currently testing prednisone, fis h oil, ACE-inhibitors, cyclophosphamide, MMF and vitamin E, In the absence of a disease-specific treatment, control of hypertension, proteinuria and p robably dyslipidemia are pivotal. Chronic or recurrent infection including tonsillitis should be treated effectively, Control of daily protein intake to 0,7-0,8 g/kg body weight may retard disease progression.