Non-immunosuppressive treatment for IgA nephropathy.
An updated Cochrane systematic review found that among non-immunosuppressive treatments for IgA nephropathy, renin-angiotensin system inhibition is the most beneficial, reducing proteinuria with a favorable balance of benefits over harms, while evidence for other non-immunosuppressive therapies remains weak.
Background
IgA nephropathy is the most common primary glomerular disease, with roughly 20 to 40 percent of patients progressing to kidney failure within 25 years. Non-immunosuppressive treatment has become a mainstay of management by improving blood pressure control and reducing proteinuria while avoiding the risks of long-term immunosuppression, but the slowly progressive course leaves many trials underpowered.
Key recommendations
This update included 80 studies with 4856 participants. Antihypertensive therapy, predominantly ACE inhibitors or angiotensin receptor blockers, was the most studied intervention. Compared with placebo or no treatment, RAS inhibition probably decreased proteinuria (mean difference -0.71 g/24 h), and against symptomatic treatment it also reduced proteinuria and serum creatinine. Tonsillectomy added to standard care may increase remission of proteinuria and hematuria, but evidence was low certainty and largely limited to Japanese patients.
Clinical implications
Antihypertensive agents, principally RAS inhibitors, appear to be the most beneficial non-immunosuppressive intervention, with benefits that outweigh harms. Evidence for anticoagulants, fish oil, and traditional medicines was insufficient to demonstrate efficacy over standard care, and the included trials were generally few, small, and too short to establish long-term kidney and cardiovascular benefits.
Category
Research
Source
Cochrane Database Syst Rev
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