Treatment of Pediatric IgA Nephropathy
Article Outline
IgA nephropathy is the most common chronic glomerulopathy in children and young adults. Although most of the early studies on pediatric IgA nephropathy concluded that it was a benign condition, more recent data have shown that a significant proportion of children progress to end-stage renal disease. It is now obvious that IgA nephropathy in children is not as benign as previously thought. Physicians who care for children with IgA nephropathy should be aware of this risk of progression to renal insufficiency and make treatment a priority. Strict attention should be given to modify any coexisting morbidities that may further predispose young patients to renal deterioration. The pharmacologic agents and therapeutic options used to manage this common disease are reviewed, and a recommended approach is presented. [Hong Kong J Nephrol 2007;9(2):70–6]
Key words: chronic glomerulopathy , end-stage renal disease , pediatric IgA nephropathy
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References
- . Is IgA nephropathy the commonest primary glomerulopathy among young adults in the USA? . Kidney Int . 2006;69:1455–1458
- . Idiopathic mesangial IgA-glomerulonephritis in childhood. Description of 19 pediatric cases and review of the literature . Eur J Pediatr . 1980;134:13–22
- . IgA nephropathy (Berger's disease) — a clinicopathologic study in children . Int J Pediatr Nephrol . 1983;4:11–18
- IgA nephropathy: long-term prognosis for pediatric patients . J Pediatr . 1995;127:913–919
- . IgA nephropathy in children from Japan. Clinical and pathological features . Child Nephrol Urol . 1988–1989;9:191–199
- . Prognostic indicators in children with IgA nephropathy — report of the Southwest Pediatric Nephrology Study Group . Pediatr Nephrol . 1994;8:15–20
- . Renal survival in pediatric patients with IgA nephropathy . Pediatr Nephrol . 2007;22:317–318
- . Glomerular morphology, natural history and treatment of children with IgA-IgG mesangial nephropathy . Pe rspect Nephrol Hypertens . 1973;1(Pt 1):305–320
- . Treatment of severe IgA nephropathy in children . Pediatr Nephrol . 1989;3:248–253
- . Double-blind, controlled trial of short-term prednisone therap y in immunoglobulin A glomerulonephritis . J Pediatr . 1992;121:474–477
- . Alternate-day prednisone therapy in children with IgA-associated nephritis . Am J Kidney Dis . 1989;13:55–60
- A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group . J Am Soc Nephrol . 1999;10:101–109
- . Rapidly progressive IgA nephropathy . Am J Dis Child . 1988;142:789–793
- . Does methylprednisolone pulse therapy deteriorate the course of rapidly progressive IgA nephropathy? . Am J Dis Child . 1989;143:441–442
- . Early start of intensive therapy in malignant form of IgA nephropathy . Nephron . 1990;54:351–353
- . Primary IgA nephropathies in children: prognosis and treatment . Adv Nephrol Necker Hosp . 1993;22:121–140
- . Treatment of rapidly progressive IgA nephropathy . Contrib Nephrol . 1995;111:177–182
- . Efficacy of prednisolone and mizoribine therapy for diffuse IgA nephropathy . Am J Nephrol . 2004;24:147–153
- . Comparison of antiproteinuric effects of two different combination therapies in children with IgA nephropathy . Clin Exp Nephrol . 2003;7:270–274
- . A comparison of corticosteroid and warfarin therapy in IgA nephropathy with crescent formation: preliminary trial . Clin Exp Nephrol . 2003;7:48–51
- . Mesangial immunoglobulin A deposits in minimal change nephrotic syndrome: a report of an older patient and review of the literature . Am J Nephrol . 1990;10:31–36
- . Occurrence of mesangial IgA and IgM deposits in a control necropsy population . J Clin Pathol . 1983;36:276–279
- . Management of IgA nephropathy: evidence-based recommendations . Kidney Int Suppl . 1999;70:S56–S62
- . Evidence-based assessment of treatment options for children with IgA nephropathies . Pediatr Nephrol . 2001;16:156–167
- . Angiotensin-converting enzyme inhibitors slow renal decline in IgA nephropathy, independent of tubulointerstitial fibrosis at presentation . QJM . 2005;98:199–203
- . Low-dose combination therapy with temocapril and losartan reduces proteinuria in normotensive patients with immunoglobulin A nephropathy . Hypertens Res . 2004;27:963–970
- . Additive antiproteinuric effect of combination therapy with ACE inhibitor and angiotensin II receptor antagonist: differential short-term response between IgA nephropathy and diabetic nephropathy . Yonsei Med J . 2003;44:463–472
- . Additive antiproteinuric effect of converting enzyme inhibitor and losartan in normotensive patients with IgA nephropathy . Am J Kidney Dis . 1999;33:851–856
- . Coadministration of losartan and enalapril exerts additive antiproteinuric effect in IgA nephropathy . Am J Kidney Dis . 2001;38:18–25
- . Combination treatment of angiotensin-II receptor blocker and angiotensin-converting enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial . Lancet . 2003;361:117–124
- CE inhibitors and angiotensin II receptor blockers in IgA nephropathy with mild proteinuria: the ACEARB study . J Nephrol . 2006;19:508–514
- . Aldosterone blockade: an emerging strategy for abrogating progressive renal disease . Am J Med . 2006;119:912–919
- Mycophenolate mofetil (MMF) vs. placebo in patients with moderately advanced IgA nephropathy: a double-blind randomized controlled trial . Nephrol Dial Transplant . 2005;20:2139–2145
- Mycophenolate mofetil alleviates persistent proteinuria in IgA nephropathy . Kidney Int . 2005;68:802–812
- Mycophenolate mofetil in IgA nephropathy: results of a 3-year prospective placebo-controlled randomized study . Kidney Int . 2004;65:1842–1849
- A randomized control trial of mycophenolate mofetil treatment in severe IgA nephropathy . Zhonghua Yi Xue Za Zhi . 2002;82:796–801 [In Chinese]
- . Immunoglobulin A nephropathy and Henoch-Schonlein purpura nephritis . In: Kher KK , Schnaper HW , Makker SP editor. Clinical Pediatric Nephrology . 2nd edition. Informa Healthcare; 2007;p. 213–221
- . Concomitant therapy with prednisolone and cyclophosphamide in 17 cases with IgA nephropathy . Nippon Jinzo Gakkai Shi . 1985;27:295–302
- Effects of triple therapy on the progression of mesangial proliferative glomerulonephritis . Clin Nephrol . 1987;27:56–64
- . Effects of triple therapy in IgA nephritis: a follow-up study 5 years later . Clin Nephrol . 1991;36:60–66
- . Controlled prospective trial of prednisolone and cytotoxics in progressive IgA nephropathy . J Am Soc Nephrol . 2002;13:142–148
- . Cyclosporin treatment of IgA nephropathy: a short term controlled trial . Br Med J (Clin Res Ed) . 1987;295:1165–1168
- Randomised controlled trial of leflunomide in the treatment of immunoglobulin A nephropathy . Nephrology (Carlton) . 2006;11:113–116
- . A controlled trial of fish oil in IgA nephropathy . N Engl J Med . 1994;331:1194–1199
- . Fish oil therapy for IgA nephropathy: efficacy and interstudy variability . J Am Soc Nephrol . 1997;8:1739–1744
- . Multicenter placebo-controlled trial of alternate-day prednisone (QOD-PRED) or daily omega-3 fatty acids (OM-3 FA) in children and young adults with IgA nephropathy (IgAN). Report from the Southwest Pediatric Nephrology Study Group . J Am Soc Nephrol . 2003;14:751A
- Vitamin E therapy in IgA nephropathy: a double-blind, placebo-controlled study . Pediatr Nephrol . 2003;18:1015–1019
- . Combined therapy with prednisolone, azathioprine, heparinwarfarin, and dipyridamole for paediatric patients with severe IgA nephropathy — is it relevant for adult patients . Nephrol Dial Transplant . 1999;14:1097–1099
- . Long-term effect of urokinase therapy in IgA nephropathy . Clin Nephrol . 1989;32:209–216
- Effects of a “single shot” of urokinase on fibrinolytic activities in patients with IgA nephropathy . Tokai J Exp Clin Med . 1984;9:43–47
- . Pathological improvement of IgA nephropathy and Henoch-Schonlein purpura nephritis with urokinase therapy . Acta Paediatr Jpn . 1996;38:622–628
- . Effects of co-administration of urokinase and benazepril on severe IgA nephropathy . Nephrol Dial Transplant . 2004;19:852–857
- Cohort study of advanced IgA nephropathy: efficacy and limitations of corticosteroids with tonsillectomy . Nephron Clin Pract . 2003;93:137–145
- The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathy . Kidney Int . 2003;63:1861–1867
- Efficacy of tonsillectomy pulse therapy versus multiple-drug therapy for IgA nephropathy . Pediatr Nephrol . 2006;21:1701–1706
- . Pediatric IgA nephropathy: clinical features at presentation and outcome for African-Americans and Caucasians . Clin Nephrol . 2004;62:167–172
PII: S1561-5413(08)60003-4
doi:10.1016/S1561-5413(08)60003-4
© 2007 The Hong Kong Society of Nephrology. Published by Elsevier Inc. All rights reserved.
