Rasche, F. M. and Keller, F. and Rasche, W. G. and Schiekofer, S. and Boldt, A. and Sack, U. and Fahnert, J. (2016) Why, when and how should immunosuppressive therapy considered in patients with immunoglobulin A nephropathy? CLINICAL AND EXPERIMENTAL IMMUNOLOGY, 186 (2). pp. 115-133. ISSN 0009-9104, 1365-2249
Full text not available from this repository. (Request a copy)Abstract
IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. Lifelong mesangial deposition of IgA1 complexes subsist inflammation and nephron loss, but the complex pathogenesis in detail remains unclear. In regard to the heterogeneous course, classical immunosuppressive and specific therapeutic regimens adapted to the loss of renal function will here be discussed in addition to the essential common renal supportive therapy. Renal supportive therapy alleviates secondary, surrogate effects or sequelae on renal function and proteinuria of high intraglomerular pressure and subsequent nephrosclerosis by inhibition of the renin angiotensin system (RAASB). In patients with physiological (GFR<15 ml/min/year) or mild (GFR 15-5 ml/min/year) decrease of renal function and proteinuric forms (> 1 g/day after RAASB), corticosteroids have shown a reduction of proteinuria and might protect further loss of renal function. In patients with progressive loss of renal function (GFR>3 ml/min within 3 months) or a rapidly progressive course with or without crescents in renal biopsy, cyclophosphamide with high-dose corticosteroids as induction therapy and azathioprine maintenance has proved effective in one randomized controlled study of a homogeneous cohort in loss of renal function (GFR). Mycophenolic acid provided further maintenance in non-randomized trials. Differentiated, precise, larger, randomized, placebo-controlled studies focused on the loss of renal function in the heterogeneous forms of IgAN are still lacking. Prospectively, fewer toxic agents will be necessary in the treatment of IgAN.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MYCOPHENOLATE-MOFETIL TREATMENT; CONVERTING-ENZYME-INHIBITOR; SEVERE IGA NEPHROPATHY; ALPHA-RECEPTOR CD89; ANTIBODY-ASSOCIATED VASCULITIS; ACID-INDUCED IMMUNOSUPPRESSION; MESANGIAL CELL-PROLIFERATION; ENTERIC-COATED MYCOPHENOLATE; INTRAVENOUS IMMUNE GLOBULIN; CARE PLUS IMMUNOSUPPRESSION; IgA nephropathy; cyclophosphamide; mycophenolic acid; corticosteroids; high dose intravenous immunoglobulines |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Psychiatrie und Psychotherapie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 27 Aug 2020 10:50 |
| Last Modified: | 27 Aug 2020 10:50 |
| URI: | https://pred.uni-regensburg.de/id/eprint/4058 |
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