Points of view in nephrology: personalized management of IgA nephropathy, beyond KDIGO

IgA nephropathy is the most common primary glomerulonephritis worldwide, and an important cause of kidney failure, as 20–40% of patients progress to renal replacement therapy 20–30 years after diagnosis. Its clinical presentation ranges from isolated microscopic hematuria to nephrotic syndrome, and...

Full description

Saved in:
Bibliographic Details
Published in:Journal of nephrology 2024-04, Vol.37 (3), p.739-745
Main Authors: Trimarchi, Hernán, Fervenza, Fernando C., Coppo, Rosanna
Format: Article
Language:English
Subjects:
Adult
Biopsy
Disease Progression
Female
Glomerulonephritis, IGA - diagnosis
Glomerulonephritis, IGA - therapy
Humans
Immunosuppressive Agents - therapeutic use
Male
Medicine
Medicine & Public Health
Middle Aged
Nephrology
Points of View
Practice Guidelines as Topic
Precision Medicine
Risk Factors
Urology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:IgA nephropathy is the most common primary glomerulonephritis worldwide, and an important cause of kidney failure, as 20–40% of patients progress to renal replacement therapy 20–30 years after diagnosis. Its clinical presentation ranges from isolated microscopic hematuria to nephrotic syndrome, and even to a rapidly progressive course. Ethnicity and epigenetics play a key role in its clinical aggressiveness. Selection of patients at risk needing immunosuppressive treatment is a challenge for the nephrologist. Some active and chronic kidney lesions detected on kidney biopsy have been demonstrated to have prognostic value according to the Oxford Classification of IgA nephropathy, later validated by numerous studies. However, KDIGO 2021 guidelines still consider persistent proteinuria > 1 g/24 h to be the most relevant risk factor for the progression of IgA nephropathy and the only one requiring immunosuppressive treatment. KDIGO guidelines have proposed a therapeutic algorithm, but many patients present peculiar characteristics that are not addressed by the current guidelines, pointing to the need for alternative approaches. In these cases, a tailored approach to each patient should be followed in which clinical, histological, laboratory, social and ethical aspects must be considered. In this manuscript we present three cases of IgA nephropathy from different countries, highlighting many of the aspects encountered in clinical practice that illustrate an individualized approach to the treatment of these patients.
ISSN:1724-6059
1724-6059
DOI:10.1007/s40620-023-01833-3