What are the treatment options for immunoglobulin A (IgA) nephropathy?

Updated: May 19, 2020
  • Author: Sohail Abdul Salim, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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The treatment of IgA nephropathy in any individual patient should be tailored to that patient's presentation, given the conflicting results of many studies of this disease. All patients should be given supportive therapy with renin-angiotensin system blockade and dietary sodium restriction. Tonsillectomy is appropriate only for patients with recurrent tonsillar infections.

Control of proteinuria is prudent, since there is a mostly linear association between the severity of proteinuria and decline in estimated glomerular filtration rate (GFR). Use of immunosuppression should be determined by considering the rate of progression, comorbidities, and whether alarming features are present on biopsy. Currently, corticosteroids are the option with the most convincing evidence to support their use; however, steroids preferably should not be given for more than 6 months.

Cyclophosphamide should be reserved for rapidly progressive crescentic glomerulonephritis. Most nephrologists agree with not using immunosuppression when the GFR is less than 30 mL/min/1.73 m2, although others would suggest a different GFR threshold. Regardless, the lower the GFR, the higher the risk of adverse events and the lower the likelihood of benefiting from immunosuppressants. Immunosuppression should definitely be avoided when the biopsy shows large amounts of interstitial fibrosis and tubular atrophy. 

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