To Treat or Not to Treat IgA Nephropathy? That Is the Question!

[摘要] IgA nephropathy (IgAN) remains one of the most common forms of idiopathic glomerulonephritis in many populations worldwide (1,2). It also is a potentially serious condition in which from 4 to 38% of patients progress to ESRD by 10 yr (2). Given its frequency and significance, there should be a consensus on which treatment strategy is optimal for patients with IgAN (1,3,4). For those who work with patients with IgAN, the reasons for a lack of consensus are obvious. First, despite progress in understanding the mechanisms that are involved in IgAN, ranging from abnormalities of galactosylation of the hinge region of the IgA molecule to altered mesangial cell binding and incitement of inflammatory mediators, the pathogenesis of the disease remains unknown (1,5). Hence, specific treatment cannot be directed at the cause of the disease, and we are forced to use less specific disease modifiers. A second problem in dealing with the treatment of IgAN is the variability of glomerular manifestations and their severity. Some patients seem to show no progression of disease over many years, whereas others present with crescentic glomerulonephritis and progress to renal failure in weeks to months. How can one treatment be effective in such a diverse disease population? A third problem is the long duration of disease progression in many patients who ultimately do experience a progressive course. All treatments with medications must include an assessment of risk versus benefit by the prescribing clinician. The longer and slower the course of disease progression, the more that potential toxicities of treatment become a factor in this cost–benefit analysis.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome