Refractory IgA Nephropathy: A Challenge for Future Nephrologists.
Vincenzo Di LeoFrancesca AnneseFederica PapadiaMaria Serena RussoMarica GilibertiFabio SallustioLoreto GesualdoPublished in: Medicina (Kaunas, Lithuania) (2024)
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.
Keyphrases
- angiotensin converting enzyme
- systematic review
- angiotensin ii
- cell proliferation
- blood pressure
- end stage renal disease
- healthcare
- chronic kidney disease
- multiple sclerosis
- newly diagnosed
- meta analyses
- high dose
- palliative care
- binding protein
- type diabetes
- emergency department
- replacement therapy
- peritoneal dialysis
- stem cells
- low dose
- cell therapy
- heart rate
- quality improvement
- pain management
- signaling pathway
- mesenchymal stem cells
- chronic pain
- smoking cessation
- health insurance
- wild type
- drug induced