Therapeutic target
- Avert deterioration of renal function
Therapy recommendations
- Stepwise therapy as follows:
- Proteinuria (increased excretion of protein in urine) > 1 g/d and normal renal function: ramipril (RAAS blockade with ACE inhibitors; result in decreased protein excretion/protein excretion and prevent disease progression (nephroprotection)).
- Proteinuria > 1 g/d and concomitant renal insufficiency (kidney weakness): therapy according to the Pozzi scheme; duration of therapy: 6 months.
- Methylprednisolone (glucocorticoids):
- Months 1, 3, and 5 – methylprednisolone 1,000 mg i.v. days 1-3, then.
- Every other day for 6 months: prednisolone 0.5 mg/kg/d p.o.
If proteinuria continues > 1g/day.
- In case of rapid progression of the disease immunosuppressive therapy with cyclophosphamide i.v.
- Mycophenolate mofetil (MMF).
- If necessary, also calcineurin inhibitors (CNI).
- Methylprednisolone (glucocorticoids):
- Additional basic therapy of hypertension (with ACE inhibitors), osteoporosis (bone loss) and, if necessary, therapy with omega-3 fatty acids (EPA and DHA).
- Studies show that glucocorticoid-ACE inhibitor combination therapy is better at delaying disease progression (progression) than with ACE inhibitor monotherapy.
- See also under “Other Therapy.”
Note
- The three-year STOP-IgAN trial demonstrated that supportive therapy, i.e., consistent blood pressure lowering and proteinuria treatment (with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists), was as effective as immunosuppressive therapy. No significant difference was demonstrated between the groups in terms of disease progression as measured by renal function loss. Only in achieving complete remission (proteinuria < 0.2 g/d and eGFR loss < 5 ml/min) did immunosuppressive therapy prove superior. This advantage was counterbalanced by a high degree of side effects.
- In the TESTING (“Therapeutic Evaluation of Steroids in IgA Nephropathy Global”) trial, after 2.1 years of follow-up, 20 patients (14.7%) in the steroid arm experienced severe complications (8.1% severe infections, which were fatal in two patients) compared with only 4 patients (3.2%) in the placebo group. However, there was a beneficial effect on renal function (risk of renal failure decreased by two-thirds), in contrast to the STOP-IgA trial.
