[Treatment of IgA nephropathy with chronic renal failure].

INTRODUCTION: About 25-50% of patients with IgA nephropathy (IgAN) progress toward end-stage renal disease (ESRD) within 25 years. Negative prognostic factors are hypertension, proteinuria >1 g/day, high values of plasma creatinine, and the extension of chronic histological lesions.

METHODS AND RESULTS: Only a few studies have evaluated the effectiveness of treatment in IgAN patients with chronic renal failure (CRF) and most of these had methodological flaws. However, some studies produced interesting results. Alexopoulos and Donadio found that the progression of IgAN slowed down with the use of omega-3 fatty acids; Woo and Nakao used angiotensin inhibitors to obtain the same result, while Ballardie used immunosuppressors. Evidence of treatment efficacy in chronic histological lesions is almost completely lacking. Yoshikawa found that a two-year course of corticosteroids and azathioprine could arrest the progression of glomerular sclerosis, and Shoji obtained similar results using corticosteroids alone for one year. In 2007 we presented the results of a study that compared corticosteroids alone vs corticosteroids and azathioprine in 253 IgAN patients. In all patients, including 46 with serum creatinine >2 mg/dL, both therapy schemes appeared effective in slowing the progression towards ESRD, even if patients in the azathioprine group experienced more side effects.

CONCLUSIONS: At the moment, Italian nephrologists preferably use ACE inhibitors alone or associated with corticosteroids in patients with IgAN and CRF. Recently, the Renal Immunopathology Group of the Italian Society of Nephrology (SIN) proposed a therapeutic study that would compare steroids and ACE inhibitors in patients with IgAN and CRF in order to provide more certain therapeutic indications.