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Update on immunoglobulin a *** Ⅱ:Clinical,diagnostic and therapeutical aspects

World Journal of Nephrology 2016年第1期5卷 6-19页

作者： Maurizio Salvadori Giuseppina Rosso Department of Renal Transplantation and Renal Diseases Careggi University Hospital Division of Nephrology San Luca Hospital

Immunoglobulin A nephropathy （igaN） is characterized by different clinical manifestations and by long-term different outcomes. Major problem for the physicians is to understanding which patients are at risk of a disease evolution and to prescribe the right therapy to the right patients. Indeed, in addition to patients with a stable disease with no trend to evolution or even with a spontaneous recovery, patients with an active disease and patients with a rapidly evolving glomeru-lonephritis are described. Several histopathological, biological and clinical markers have been described and are currently used to a better understanding of patients at risk, to suggest the right therapy and to monitor the therapy effect and the igaN evolution over time. The clinical markers are the most reliable and allow to divide the igaN patients into three categories： The low risk patients, the intermediate risk patients and the high risk patients. Accordingly, the therapeutic measures range from no therapy with the only need of repeated controls, to supportive therapy eventually associated with low dose immunosuppression, to immunosuppressive treat-ment in the attempt to avoid the evolution to end stage renal disease. However the current evidence about the different therapies is still matter of discussion. New drugs are in the pipeline and are described. They are object of randomized controlled trials, but studies with a number of patients adequately powered and with a long follow up are needed to evaluate effcacy and safety of these new drugs.

关键词： iga nephropathy prevention and control iga nephropathy iga nephropathy diagnosis iga nephropathy prognosis iga nephropathy classifcation iga nephropathy therapy

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