Blog entry by mohammad katout
Prof. Bassam Saeed blogged:
New KDIGO guidelines for IgA nephropathy
Immunosuppressants should only be considered in high risk patients after optimizing supportive measures.
• We suggest that patients with persistent proteinuria ≥1 g/d, despite three to six months of optimised supportive care (including ACE-I or ARBs and BP control) and GFR >50 ml/min, receive a six-month course of corticosteroid therapy
Immunosuppressive agents (cyclophosphamide, azathioprine, MMF, cyclosporine)
• We suggest not treating with corticosteroids combined with cyclophosphamide or azathioprine in IgAN patients (unless there is crescentic IgAN with rapidly deteriorating kidney function
• We suggest not using Immunosuppressive therapy in patients with GFR <30 ml/min unless there is crescentic IgAN with rapidly deteriorating kidney function
• We suggest not using MMF in IgAN
Atypical forms of IgAN
• We suggest using steroids and cyclophosphamide in patients with IgAN and rapidly progressive crescentic IgAN (Defined as IgAN with crescents in more than 50 % of glomeruli in the renal biopsy with rapidly progressive renal deterioration), analogous to the treatment of ANCA vasculitis.
From these guidelines it is clear that immunosuppression should only be considered in high risk patients after supportive measures have been optimized
If immunosuppression is considered, the only recommended approach is corticosteroid monotherapy for six months.