Treatment of IgA nephropathy and Henoch-Schonlein nephritis

被引:69
作者
Floege, Juergen [1 ,2 ]
Feehally, John [3 ]
机构
[1] Rhein Westfal TH Aachen, Div Nephrol, D-52057 Aachen, Germany
[2] Rhein Westfal TH Aachen, Div Immunol, D-52057 Aachen, Germany
[3] Leicester Gen Hosp, John Walls Renal Unit, Leicester LE5 4PW, Leics, England
关键词
IMMUNOGLOBULIN-A NEPHROPATHY; OXFORD CLASSIFICATION; LONG-TERM; MYCOPHENOLATE-MOFETIL; CLINICOPATHOLOGICAL CORRELATIONS; DISEASE PROGRESSION; PROSPECTIVE TRIAL; NATURAL-HISTORY; ACE-INHIBITORS; CLINICAL-TRIAL;
D O I
10.1038/nrneph.2013.59
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Treatment options for primary IgA nephropathy (IgAN) and Henoch-Schonlein nephritis are still largely based on opinion or weak evidence. Consequently, the recent KDIGO Clinical Practice Guidelines for Glomerulonephritis have assigned low levels of evidence for almost all recommendations and suggestions related to these two diseases. In this Review, we describe an algorithm for structuring the treatment of IgAN depending on the clinical scenario. Key to therapeutic decision making is assessment of the individual's prognosis. Clinical parameters (such as proteinuria, hypertension, and impaired glomerular filtration rate [GFR]) are used to estimate risk, but the clinical value of the novel histological Oxford-MEST classification remains to be determined. If these parameters indicate a risk of progressive GFR loss, comprehensive supportive care remains the mainstay of therapy. Two large trials, STOP-IgAN and TESTING, are underway to evaluate the value of adding corticosteroids after initiating such supportive care. At present, little evidence exists to suggest that any other immunosuppressive therapy beyond corticosteroids is effective in either IgAN or Henoch-Schonlein nephritis.
引用
收藏
页码:320 / 327
页数:8
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