NDT Advance Access originally published online on May 25, 2004
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Nephrol Dial Transplant (2004) 19: 1947-1951
Nephrol Dial Transplant Vol. 19 No. 8 © ERA-EDTA 2004; all rights reserved
Editorial Comment
Treatment options for IgA nephropathy in adults: a proposal for evidence-based strategy
1 Service de Néphrologie, Université Claude-Bernard Lyon 1, Hôpital Edouard-Herriot, Lyon, France and 2 Service de Néphrologie, Dialyse et Transplantation Rénale, Université Jean-Monnet, Hôpital Nord, Saint-Etienne, France
Correspondence and offprint requests to: Prof. Maurice Laville, Service de Néphrologie, Pavillon P, Hôpital Edouard-Herriot, 5 place d’Arsonval, F-69437 Lyon, France. Email: maurice.laville@chu-lyon.fr
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Introduction |
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Treatment of patients with IgA nephropathy (IgAN) remains a matter of debate. Why, given that IgAN is the most prevalent glomerulonephritis in several countries, does it cause end-stage renal disease (ESRD) in 15–20% of patients within 10 years of the apparent onset of disease, and account for 10% of incident ESRD patients?
At a first look, this results from the heterogeneity of patients referred for IgAN. In fact, there are important differences in renal biopsy policy between centres and countries, leading to very dissimilar patient populations at inclusion in treatment protocols. Most of the patients have only a far potential diagnosis lacking histological documentation, and some are seen only at late stages of renal disease, precluding accurate treatment evaluation and inclusion in controlled studies. Finally, patients have different lengths of disease course, associated with distinct evolution potentials as assessed by the severity of either clinical presentation or histological lesions.
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Risk factors |
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The
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Treatment efficacy |
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Fish oil
Steroids
Anti-proteinuric treatments
Immunosuppressants
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Decision analysis |
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Conclusions |
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