Treatment of IgA Nephropathy: An Update

2011 ◽  
Vol 45 (10) ◽  
pp. 1284-1296 ◽  
Author(s):  
Jennifer L Rosselli ◽  
Stacey M Thacker ◽  
Julie P Karpinski ◽  
Katherine A Petkewicz
Keyword(s):  
Blood Pressure ◽  
Iga Nephropathy ◽  
Treatment Options ◽  
Immunoglobulin A ◽  
Omega 3 ◽  
Immunoglobulin A Nephropathy ◽  
Angiotensin Ii Receptor ◽  
Urine Protein ◽  
Converting Enzyme Inhibitors ◽  
Medline Search

Objective: To review current literature regarding treatment options for immunoglobulin A nephropathy (IgAN). Data Sources: A MEDLINE search was performed using the terms IgA nephropathy, Berger's disease, immunoglobulin A nephropathy, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, fish oil, omega-3 fatty acids, statins. hydroxymethylglutaryl-CoA reductase Inhibitors, immunosuppressive therapy, corticosteroids, mycophenolate mofetil, cyclophosphamide, cyclosporine, azathioprine, leflunomide, antiplatelets, anticoagulants, vitamin E, infliximab, calcitriol, and intravenous immunoglobulins. A date limit was not set; however, focus was on publications from 1999 to June 2011 to review recent literature and therapeutic recommendations. Study Selection and Data Extraction: All articles in English, including studies conducted in humans, meta-analyses, review articles, guidelines, statements, and reference citations, were identified and evaluated. Data Synthesis: IgAN is the most common primary glomerulonephritis worldwide, leading to end-stage renal disease in 20–30% of patients. Evidence guiding management of IgAN has been sparse and clinical trials have not conclusively demonstrated effective treatments, largely due to suboptimal methodologies. Treatment strategies have included management of blood pressure and lipids, improvement or stabilization of kidney function, and reduction of proteinuria. This review of IgAN provides an update regarding standard and nonconventional treatment options based on recently published literature. Conclusions: Supportive therapies, including angiotensin blockade, should be considered as first-line therapy for patients with urine protein >0.5 g/day and/or blood pressure > 140/90 mmHg, Corticosteroids could be considered as add-on or monotherapy for patients with urine protein >1 g/day with preserved renal function. Conclusive data are lacking for general treatment recommendations for the use of other therapies for IgAN.

Aggregation of erythrocyte sodium/lithium countertransport activity in families of patients with immunoglobulin A nephropathy

1992 ◽  
Vol 83 (2) ◽  
pp. 241-245 ◽  
Author(s):  
A. Fabbri ◽  
R. Boero ◽  
E. Degli Esposti ◽  
C. Guarena ◽  
A. Lucatello ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Iga Nephropathy ◽  
Poor Prognosis ◽  
Genetic Factors ◽  
Immunoglobulin A ◽  
Mean Blood Pressure ◽  
Immunoglobulin A Nephropathy ◽  
Normal Range ◽  
Erythrocyte Sodium

1. We evaluated the inheritance of erythrocyte Na+/Li+ countertransport activity in IgA nephropathy by assessing this parameter in 19 patients with biopsy-proven IgA nephropathy and in their 53 relatives (32 parents and 21 siblings). The possible use of erythrocyte Na+/Li+ countertransport activity as a marker of poor prognosis was also evaluated. 2. A significant correlation was found between ‘familial’ and proband Na+/Li+ countertransport activity, but not between that of spouses. 3. Mean blood pressure, although within the normal range, and Na+/Li+ countertransport activity were significantly higher in patients with proteinuria than in those without proteinuria. 4. Parents of proteinuric patients had a higher Na+/Li+ countertransport activity than parents of non-proteinuric patients. 5. In IgA nephropathy the inheritance of erythrocyte Na+/Li+ countertransport activity was preserved. Therefore genetic factors could play a role in the non-immunological progression of IgA nephropathy.

Immunoglobulin A nephropathy and IgA vasculitis (HSP)

2020 ◽  
pp. 4909-4917
Author(s):  
Jonathan Barratt ◽  
John Feehally
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Iga Nephropathy ◽  
Systemic Vasculitis ◽  
Treatment Options ◽  
Immunoglobulin A ◽  
Kidney Injury ◽  
Oral Prednisolone ◽  
Immunoglobulin A Nephropathy ◽  
Renal Vasculitis

Immunoglobulin A nephropathy (IgAN) is the commonest pattern of glomerulonephritis identified in areas of the world where renal biopsy is widely practised. It is defined pathologically by IgA deposition in the glomerular mesangium accompanied by a mesangial proliferative glomerulonephritis which may vary greatly in severity. Aetiology is uncertain, but abnormalities of IgA1 hinge-region O-glycosylation are consistently found. Clinical features—IgAN can present with (1) visible haematuria, typically in children and young adults, developing within a day or two of upper respiratory tract infection (‘synpharyngitic’); (2) asymptomatic nonvisible haematuria/proteinuria; (3) nephrotic syndrome (<5% of cases); (4) acute kidney injury (uncommon); and (5) chronic renal failure with up to 25% of patients reaching endstage renal failure within 20 years of diagnosis. Henoch–Schönlein purpura (HSP) is a small vessel systemic vasculitis characterized by small blood vessel deposition of IgA that predominantly affects the skin, joints, gut, and kidney, with nephritis that may be histologically indistinguishable from IgA nephropathy. Management—there is no treatment known to modify mesangial deposition of IgA. Treatment options are mostly directed at controlling blood pressure and limiting proteinuria through blockade of the renin–angiotensin–aldosterone axis. In the rare patient presenting with acute kidney injury in whom biopsy shows crescentic IgA nephropathy, a regimen such as those used for renal vasculitis and other forms of crescentic glomerulonephritis should be considered, for example, oral prednisolone in combination with cyclophosphamide.

Immunoglobulin A nephropathy

2018 ◽  
Author(s):  
Kar Neng Lai ◽  
Sydney C. W. Tang
Keyword(s):  
Blood Pressure ◽  
Immunoglobulin A ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Convincing Evidence ◽  
High Dose ◽  
Immunoglobulin A Nephropathy ◽  
Recurrent Tonsillitis ◽  
Converting Enzyme Inhibitors ◽  
End Stage

Immunoglobulin A nephropathy is characteristically slowly evolving, and studies from autopsies and kidney donors show that deposition of immunoglobulin A is quite common and not necessarily associated with overt disease. However, series of biopsy-diagnosed patients that extend to 20 or 30 years report rates of end-stage renal failure of up to 40–50%. A very approximate overall rate of end-stage renal disease of 1% per year has been suggested. Proteinuria, glomerular filtration rate (GFR), and possibly some features on renal biopsies enable risk stratification, but all patients need long-term monitoring. Treatment is based on the use of angiotensin converting-enzyme inhibitors for patients with proteinuria, and blood pressure control, and of course during most of the previous long-term studies patients would not have been treated with these agents or to modern blood pressure standards. For patients who show loss of GFR despite this, or other markers of high risk, the best evidence is for treatment with high-dose corticosteroids over a limited period of months. There is little convincing evidence for additional benefit from cytotoxic or other immunomodulatory agents, except possibly in the most aggressive disease, when there is weak evidence for cyclophosphamide. Some studies claim benefit from tonsillectomy, but this is not clear, and most nephrologists only recommend this for patients with recurrent tonsillitis.

scholarly journals Prediction Models of Albumin Renal Excretion in Type 2 Diabetes Mellitus Patients

2019 ◽  
Vol 70 (11) ◽  
pp. 3802-3807
Author(s):  
Amorin Remus Popa ◽  
Claudia Teodora Judea Pusta ◽  
Cosmin Mihai Vesa ◽  
Simona Bungau ◽  
Camelia Liana Buhas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Positive Correlation

Microalbuminuria is a cardiovascular risk factor in type 2 diabetes mellitus patients. It is very important to know which the predictor factors for albuminuria are, because these elements may be influenced by pharmacological measures. In our study we propose three models for the prediction of albumin glomerular excretion in a group of 446 type 2 diabetes mellitus patients: the clinical-biochemical model, the pharmacological model, and the integrative model that reunites the two models. In the clinical-biochemical model, albumin excretion was statistically significant influenced by HbA1c (positive correlation) and blood pressure (positive correlation). In the pharmacological model, albumin excretion was influenced by angiotensin converting enzyme inhibitors or angiotensin II receptor blockers treatment (negative correlation). In the integrative model, the factors were HbA1c (positive correlation), diastolic blood pressure (positive correlation), angiotensin converting enzyme inhibitors or angiotensin II receptor blockers treatment (negative correlation) and statins treatment (negative correlation). The prevalence of microalbuminuria was 16.14 %. Patients with microalbuminuria had statistically significant higher values of HbA1c, systolic blood pressure, diastolic blood pressure, triglycerides and lower values of HDL-cholesterol. A low glucose control was the most important risk factor for an increased albumin glomerular elimination. The importance of our study consists in the fact that all the elements that predict albuminuria can be influenced: HbA1c, blood pressure, therapy with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers and statins.

scholarly journals Sodium Sensitivity of Blood Pressure Appearing Before Hypertension and Related to Histological Damage in Immunoglobulin A Nephropathy

Hypertension ◽  
2001 ◽  
Vol 38 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Yoshio Konishi ◽  
Noriyuki Okada ◽  
Mikio Okamura ◽  
Takashi Morikawa ◽  
Michiaki Okumura ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Immunoglobulin A ◽  
Immunoglobulin A Nephropathy ◽  
Sodium Sensitivity ◽  
Histological Damage

Plasma fractalkine levels are associated with renal inflammation and outcomes in immunoglobulin A nephropathy

2018 ◽  
Vol 34 (9) ◽  
pp. 1549-1558 ◽  
Author(s):  
Ran Luo ◽  
Shui-Ming Guo ◽  
Yue-Qiang Li ◽  
Yi Yang ◽  
Meng-Lan Li ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Creatinine Level ◽  
Mesangial Cells ◽  
Immunoglobulin A ◽  
Renal Tissue ◽  
Chinese Patients ◽  
Renal Outcome ◽  
Immunoglobulin A Nephropathy ◽  
Urine Protein ◽  
Mesangial Hypercellularity

Abstract Background A recognized noninvasive biomarker to improve risk stratification of immunoglobulin A nephropathy (IgAN) patients is scarce. Fractalkine has been shown to play a key role in glomerular disease as chemoattractant, adhesion and even fibrosis factor. The current study assessed the possibility of plasma fractalkine as a novel biomarker in IgAN patients. Methods Plasma fractalkine was measured in 229 patients with renal biopsy consistent IgAN from 2012 to 2014, and clinical, pathological and prognostic relationships were analyzed. Results The plasma fractalkine levels in IgAN patients were significantly correlated with the creatinine level and 24-h urine protein by both univariate and multivariate analysis. Mesangial hypercellularity was still significantly correlated with the plasma fractalkine levels even after adjustment for other potential predictor variables by multivariate analysis. In addition, the counts of CD20+ B cells or CD68+ macrophage in renal biopsies of IgAN patients were significantly correlated with the plasma fractalkine levels, but not CD4+ and CD8+ T cells. Finally, we concluded that patients with higher plasma fractalkine levels had higher risk of poor renal outcome compared with those with lower plasma fractalkine levels. No association was observed between the CX3CR1 polymorphisms and clinical parameters including plasma fractalkine levels and prognosis. Recombinant fractalkine induced mesangial cells extracellular matrix synthesis and promoted the migration of microphage cells RAW264.7. Conclusions Plasma fractalkine levels were associated with creatinine level, 24-h urine protein, mesangial hypercellularity pathological damage, the CD68+ macrophage and CD20+ B cell infiltration in renal tissue and renal outcome in IgAN patients. Plasma fractalkine might be a potential prognosis novel predictor in Chinese patients with IgAN.

scholarly journals Safety and Efficacy of Imidapril in the Treatment of Essential Hypertension

2011 ◽  
Vol 3 ◽  
pp. CMT.S7662
Author(s):  
Masashi Okamura ◽  
Susumu Ogawa ◽  
Sadayoshi Ito
Keyword(s):  
Blood Pressure ◽  
Current Knowledge ◽  
Meta Analysis ◽  
Renin Angiotensin System ◽  
Ace Inhibition ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Beneficial Effects ◽  
Pressure Independent ◽  
Ras Inhibitors

Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are one of the renin angiotensin system (RAS) inhibitors widely used for the treatment of hypertension. Recently, Blood Pressure Lowering Treatment Trialists’ Collaboration (BPLTTC) meta-analysis showed that ACEIs had the blood pressure independent beneficial effects on coronary heart events. In this review, we summarized our current knowledge about ACEIs especially imidapril and re-evaluated ACEIs among other RAS inhibitors (RASIs) because ACEIs have wide ranges of beneficial effects in addition to the ACE inhibition which other RASIs do not have such as the up-regulation of bradykinin level, substance P level, the inhibition of matrix metalloproteinase (MMP) activity and stabilization of coronary plaque.

Sign in / Sign up

Export Citation Format

Share Document