treatment

IgA Nephropathy The ideal treatment should remove IgA from the glomeruli and prevent post-IgA deposition. This goal remains a long-term prospect. There are a number of treatment IgA nephropathy need attention. IgA nephropathy variable course, from a benign periodic hematuria to the rapid development of chronic renal failure. Therefore, patient therapy should be based on prognostic conditions and the risk of progression. Although renal transplant patients with cyclosporine and imidazole thiopurine, mycophenolate mofetil steroids and other drugs, IgA nephropathy will also relapse. The limited number of randomized controlled patients so far is difficult to provide a meaningful statistical basis for individual differences in IgA nephropathy, the diversity of treatment options, and the length of follow-up.

Patients with isolated hematuria, proteinuria <1g / d and normal renal function in patients with good progress, routine annual follow-up. Attention to tonsillitis such as induced hematuria of the disease, tonsil removal can reduce the risk of such problems. But it can not reduce the incidence of progressive renal failure. Similarly, the natural history of the disease is such that, over time, the occurrence of frank hematuria will be reduced, regardless of any particular treatment. Similarly, prophylactic antibiotics are not beneficial. In order to reduce the mucosal antigen response, limiting gluten diet can not protect renal function. Phenytoin also no effect.

IgA nephropathy in patients with light microscopy showed minimal changes in nephropathy and clinical patients with nephrotic syndrome, severe reactions to steroids, the performance of somewhat like a small lesion nephropathy. In other patients, the steroid response was less intense. Short-term high-dose steroid therapy is not good. In the normal renal function associated with proteinuria (1-3.5g / d), recent prospective studies have shown that steroid 6 months regimen may reduce proteinuria and preservation of renal function. However, this is to assess the risk of steroid long-term use. Note that a 10-year follow-up of a patient does indicate the benefits of steroid therapy. In the steroid-treated group, the risk of renal failure was lower. The focus is on the use of vascular-mediated tread-in enzyme inhibitors in both groups.

Randomized IgA nephropathy patients with cyclophosphamide combined with platelet inhibitors / anticoagulants produce contradictory results. The side effects of this drug also include the long-term use of increased risk of cancer and infertility, which is not suitable for young adults to use. A recent study carefully selected high-risk populations with GFR decline, the results show that the first 3 months of combined use of steroids and cyclophosphamide, and then at least 2 years of imidazole thiopurine significantly increased the preservation of renal function. Other drugs, such as mycophenolate mofetil, environmental protection Ling, imidazolid treatment of different effects.

The Mayo Clinic study showed that long-term treatment with omega-3 fatty acids slows the onset of renal failure but does not reduce proteinuria in high-risk patients with a partial deterioration of renal function. However, these results were not performed in other study groups and subsequent meta-analyzes. The cod liver oil treatment did not appear the shortcomings of immunosuppressive therapy. At the same time in addition to bad taste and abdominal discomfort outside the relative or relatively safe.

The cause of renal failure is not just IgA, rather than specific treatment is also good. Including low-protein diet, to control blood pressure. As long as the blood pressure control in the ideal level, against the requirements of hypertension is not strict. And angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists with anti-proteinuria role is also good.

Genetics [edit]

Although many studies have suggested that the disease is genetically related, no suspicious gene has yet been identified. Related studies suggest that may be related to C4 invalid allele, factor BB allele, MHC antigen and IgA phenotype related. ACE gene polymorphism (D allele) is associated with progression of renal failure, similar to other causes associated with chronic renal failure. However, more than 90% of IgA nephropathy is sporadic, and some large family descriptions are derived from Kentucky and Italy.

Prognosis [edit]

Men, proteinuria (especially> 2g / d) older, smoking, high blood pressure, high cholesterol and other similar diseases and high concentrations of creatinine in patients with poor prognosis. Simple hematuria in patients with different prognosis, most studies show a better prognosis, which is related to early diagnosis, only a group of data reported poor prognosis. Proteinuria and hematuria were the most important prognostic factors in this group.

Of course, there are other features on the renal biopsy, such as the gap scar is often poor prognosis. Recently, ACE gene polymorphisms have been implicated in the DD genotype, which is often associated with renal failure.