Refractory IgA Nephropathy: A Challenge for Future Nephrologists

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2024-02, Vol.60 (2), p.274
• Main Authors: Di Leo, Vincenzo, Annese, Francesca, Papadia, Federica, Russo, Maria Serena, Giliberti, Marica, Sallustio, Fabio, Gesualdo, Loreto
• Format: Article
• Language: English
• Subjects: Angiotensin; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - therapeutic use; B cells; Cell differentiation; Chronic kidney failure; Clinical trials; complement cascades; Corticosteroids; Development and progression; Diabetes; Drug dosages; Endothelin; Enzyme inhibitors; Enzymes; fecal microbiota transplantation; Forecasts and trends; Glomerulonephritis, IGA - drug therapy; Glucose; Humans; Hypoglycemic agents; Immunoglobulin A; Immunosuppressive Agents - therapeutic use; Infections; Kidney diseases; Kidney Failure, Chronic - therapy; Methylprednisolone; Microbiota (Symbiotic organisms); Mycophenolate mofetil; Nephrologists; new drugs; Pathogenesis; Rankings; refractory IgA nephropathy; SGLT2 inhibitors; Steroids; Steroids - therapeutic use
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60020274

IgA nephropathy (IgAN) represents the most prevalent form of primary glomerulonephritis, and, on a global scale, it ranks among the leading culprits behind end-stage kidney disease (ESKD). Presently, the primary strategy for managing IgAN revolves around optimizing blood pressure and mitigating proteinuria. This is achieved through the utilization of renin-angiotensin system (RAS) inhibitors, namely, angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs). As outlined by the KDIGO guidelines, individuals who continue to show a persistent high risk of progressive ESKD, even with comprehensive supportive care, are candidates for glucocorticoid therapy. Despite these therapies, some patients have a disease refractory to treatment, defined as individuals that present a 24 h urinary protein persistently >1 g after at least two rounds of regular steroids (methylprednisolone or prednisone) and/or immunosuppressant therapy (e.g., mycophenolate mofetil), or who do not tolerate regular steroids and/or immunosuppressant therapy. The aim of this Systematic Review is to revise the current literature, using the biomedical database PubMed, to investigate possible therapeutic strategies, including SGLT2 inhibitors, endothelin receptor blockers, targeted-release budesonide, B cell proliferation and differentiation inhibitors, fecal microbiota transplantation, as well as blockade of complement components.