Nephrol Dial Transplant (2003) 18: 241-245
© 2003 European Renal Association-European Dialysis and Transplant Association
Editorial Comment
Evidence-based recommendations for immunosuppression in IgA nephropathy: handle with caution
Division of Nephrology and Immunology, University of Aachen, Aachen, Germany
Keywords: evidence-based recommendations; hypertension, ACE inhibitor; grading system; IgA nephropathy; immunosuppression; proteinuria
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Introduction
In 1999, Nolin and Courteau [1] published evidence-based recommendations (Table 1
) for the management of IgA nephropathy (IgAN). They concluded that ‘... patients with mild histopathological changes, proteinuria over 3 g/day, and a creatinine clearance above 70 ml/min should be treated with prednisone for 4–6 months. An initial dose of 1 mg/kg/day is recommended, with alternate day administration and gradual tapering after eight weeks in response patients. Steroids reduce proteinuria (grade B recommendation) and stabilize kidney function (grade C) ...’ [1]. These recommendations were based on a small randomized controlled trial by Lai et al. [2] as well as a retrospective [3] and a prospective controlled trial by Kobayashi et al. [4]. Nolin and Courteau also concluded that the therapeutic usage of cyclophosphamide, cyclosporin A and azathioprine was not supported by sufficient data and that ‘... hypertension
Available new studies since 1999
Control of hypertension
Control for other progression factors
Conclusion
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