Appel G B, Waldman M
Department of Medicine, Division of Nephrology, Columbia Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Kidney Int. 2006 Jun;69(11):1939-44. doi: 10.1038/sj.ki.5000434.
Although IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide, our understanding of the pathogenesis of this complex disease remains limited. IgA nephropathy may appear with a variety of clinical presentations, a number of different clinical and histopathologic risk factors for progressive renal disease, and a very variable course over time. Thus, it is not surprising that a single therapeutic treatment plan has not been established. Many of the studies dealing with IgAN are retrospective, lack statistical significance, or have confounding designs, which hinder their general acceptance. Nevertheless, a number of well-designed studies have been performed. This paper reviews currently available therapeutic options for IgAN. It attempts to address several important questions: Why do we treat patients with IgAN? How do we decide which patients should be treated? What are the general treatment guidelines for all IgAN patients? What is the role of specific therapy such as fish oils, tonsillectomy, and immunosuppression in the treatment of patient with IgAN? It also addresses several on-going trials and goals for future therapeutic studies for IgAN patients.
尽管IgA肾病（IgAN）是全球原发性肾小球肾炎最常见的形式，但我们对这种复杂疾病发病机制的了解仍然有限。IgA肾病可能表现出多种临床症状、一些不同的进展性肾病临床和组织病理学危险因素，以及随时间变化差异很大的病程。因此，尚未制定出单一的治疗方案也就不足为奇了。许多关于IgA肾病的研究都是回顾性的，缺乏统计学意义，或者设计存在混淆因素，这阻碍了它们被普遍接受。然而，已经开展了一些设计良好的研究。本文综述了目前针对IgA肾病的治疗选择。它试图回答几个重要问题：我们为什么要治疗IgA肾病患者？我们如何决定哪些患者应该接受治疗？所有IgA肾病患者的一般治疗指南是什么？鱼油、扁桃体切除术和免疫抑制等特定疗法在IgA肾病患者治疗中的作用是什么？它还讨论了一些正在进行的试验以及IgA肾病患者未来治疗研究的目标。
