Treatments of IgA Nephropathy
The Committee on IgA nephropathy in Japan has published new clinical guidelines (2nd edition) for the diagnosis and treatment of patients with this disease. The nonspecific therapeutic approach involves a reduction of dietary intake of protein in patients with IgA nephropathy who have developed renal failure. At present, the most important therapeutic goal in patients with IgA nephropathy is the control of hypertension. It has been assumed that removal of tonsillar tissues might reduce the production of polymeric IgA and decrease the frequency of renal parenchymal damage resulting from episodes of macroscopic hematuria and proteinuria. Although there have been no randomized controlled trials (RCT) of tonsillectomy, these are necessary to determine the efficacy of tonsillectomy in patients with IgA nephropathy.
The treatments of IgA nephropathy are as follows:
1. The hypertensives should control blood pressure and maintain within usual level to remiss hemodynamics and aggravate the primary renal lesions because of the damage of blood vessel.
2. Patients with the hematuresis recurrent attacks can excise the tonsil. We should use strong antibiotic at the time the upper respiratory infection breaks out. Some IgA nephropathies can reduce its incidence.
No accepted therapy has been established for progressive immunoglobulin A (IgA) nephropathy.
Studies suggests that our protocol had an antiproteinuric effect, but could not improve kidney survival. Because the effect of steroid therapy to prevent the progression of IgA nephropathy is believed to be linked closely to reduction in urinary protein, an insufficient dose of prednisolone in our protocol may be the reason for the discrepancy between the effect on proteinuria and kidney survival.
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