NDT Advance Access originally published online on April 1, 2007
Nephrology Dialysis Transplantation 2007 22(6):1785; doi:10.1093/ndt/gfm069
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IgA Nephritis—Ace inhibitors, steroids etc?
Email: nigel{at}edwinwardle.freeserve.co.ukSir,
The review by Francesco Locatelli and colleagues [1] will surely become the basis for further therapeutic trials. However, I wish to raise three points, if you please. Firstly, the rationale for using ACEIs and Angiotensin Receptor Blocker (ARBs) is to control systemic and glomerular hypertension and proteinuria. Yet it is an uncomfortable undoubted fact, concerning which there is a deficiency of recording, that some 25% patients have to abandon ACEIs owing to their side-effects, and another ill-defined percentage of patients have to forsake ARBs. There are patients who cannot take either form of drug. One has to bring this matter into the open. I suspect that there could be racial/pharmacogenetic factors to be considered. The reality is that patients may instead have to take calcium channel blockers.
Secondly, many units still prescribe aspirin, and that is fine, for aspirin is an anti-thromboxane and even an immuno-proteasomal inhibitor [2]. I recently drew attention to the continued need for consideration of antithromboxanes [3]. The relevance of thromboxane to the pathophysiology of IgA nephritis has to be continually stressed [4], and each new generation of physicians should be reminded. It is a shame that the pharmaceutical industry did not see fit to continue the manufacture of those antithromboxanes, into whose development they had invested so much!
Thirdly, Locatelli et al. [1] mention patients with rapidly progressive IgA nephropathy. In Nephron 1998,79, p. 221, I mentioned the use of melphalan in two patients, in whom a gratifying amelioration was achieved. Since I had previously worked in haematology, I knew how to cope with the leucopaenia for 3 weeks and the associated outbreak of herpes zoster in one patient. Melphalan is a viable consideration.
Conflict of interest statement. None declared.
London NW1 8JS
References
- Locatelli F, Pozzi C, Andrulli S. IgA nephritis:ACE inhibitors, steroids,both or neither? Nephrol Dial Transplant (2006) 21:3357–3361.
[Free Full Text] - Dikshit P, Chatterjee M, Goswami E, et al. Aspirin induces apoptosis through the inhibition of proteasome function. J Biol Chem (2006) 281:29228–29235.
[Abstract/Free Full Text] - Wardle EN. Renal protection in immunoglobulin-A nephropathy. Nephrol Dial Transplant (2006) 21:1136.
[Free Full Text] - Wardle EN. Rationales for treating IgA nephropathies. Renal Failure (2000) 22:1–6.[CrossRef][Web of Science][Medline]
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