Mechanisms and management of IgA nephropathy progression to end-stage renal disease: From the "four-hit" theory to precision medicine.

What was studied

This was a review of IgA nephropathy (IgAN). It is the most common primary glomerulonephritis worldwide. Many people reach end-stage kidney disease (ESKD) within 20 years. The team traced progression from cause to ESKD. They also looked at care plans based on risk groups. They read papers on cause, risk and care.

What they found

The multi-hit theory drives progression, and abnormal complement activation amplifies injury. The strongest predictors are ongoing proteinuria and high blood pressure. Tubular atrophy/interstitial fibrosis (T lesion) on biopsy is also a strong predictor. Care uses risk groups built from clinical and biopsy signs. RASi and SGLT2 inhibitors are the base of supportive care for all with proteinuria. Steroids or new drugs may be considered for fast progressors at high risk.

What it means for patients

The authors said IgAN care has entered the era of precision medicine. They said the core is linking mechanism research, risk prediction and varied care. This would slow disease progression.

Why it is not certain yet

The abstract does not say how many papers were read. Steroids or new drugs are for some people, as needed. A review of papers can only reflect what is in print.

Source

Mechanisms and management of IgA nephropathy progression to end-stage renal disease: From the "four-hit" theory to precision medicine.

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