[Immunosuppressive therapy in IgA glomerulonephritis with chronic renal failure: case study presentation and literature review].

Immunosuppressive treatment of IgA Nephropathy (IgAN) with chronic renal failure (CRF) is still a controversial issue, because of scepticism on expected results and possible side effects of therapy. There is a "point of no return" (serum creatinine of 3 mg/dL), after which the deterioration of renal function becomes inevitable. We report the case of a 24-year-old woman, with advanced IgAN (serum creatinine > 3 mg/dL), who experienced remission of proteinuria and long-lasting stabilisation of renal function, after treatment with a 6-month steroid course. Literature information on the therapy for advanced phases of IgAN is inadequate. Our multicenter randomised controlled trial, aimed at evaluating the effects of a 6-month steroid course, included 18 patients with mild CRF at baseline. The ten patients that we treated experienced better renal survival than the eight patients who received no steroids, with an expected renal survival of 29.5 and 6.5 years, respectively. In a prospective study of patients with serum creatinine of 1.6 - 2.9 mg/dl, Ballardie and Roberts compared 19 patients treated with immunosuppressive drugs and 19 control patients: renal survival at 5 years was 72% in treated and 5% in control patients. Goumenos et al. retrospectively evaluated 39 patients treated with steroids and azathioprine and 22 untreated patients: a non-progressive course was observed in 79.5% of treated patients and in 36% of untreated patients. Tsuruya et al. retrospectively examined 26 patients treated with steroids and cyclophosphamide and 19 untreated patients: the expected renal survival was of 5.2 years in treated and 4.8 years in untreated patients, respectively. Prospective controlled trials are essential for evaluating the real effectiveness of immunosuppressive therapy in IgAN patients with impaired renal function. We have recently proposed a study to compare steroids alone and steroids plus azathioprine, because it is mandatory to look for safe and effective therapies that delay as much as possible the start of dialysis, also in patients with already established CRF.