Division of Nephrology and Hypertension, University of Louisville, Louisville, Kentucky.
Division of Nephrology, Stanford University Medical Center, Stanford, California.
Am J Kidney Dis. 2024 Feb;83(2):229-240. doi: 10.1053/j.ajkd.2023.08.007. Epub 2023 Sep 23.
IgA nephropathy (IgAN) is the most common glomerular disease in the world. However, the approach to treatment remains controversial. There has been an explosion of clinical trials over the past decade both to further examine corticosteroid use and usher in additional treatment considerations, including 2 newly approved therapies for IgAN. Sodium glucose cotransporter 2 inhibitors are proving to be effective therapy across proteinuric chronic kidney diseases, and IgAN is not likely to be an exception. Further supportive agents are looking highly promising and so are novel agents that specifically focus on the pathophysiology of this disease, including endothelin blockade, complement inhibition, and B-cell targeted strategies. We suggest a present-day approach to treatment of individuals with IgAN, expose the limitations in our knowledge, and discuss new treatments that may arise, hoping they come with evidence about optimal utilization. Change appears to be inevitable for our approach to the treatment of IgA nephropathy. This is truly an exciting and optimistic time.
IgA 肾病（IgAN）是世界上最常见的肾小球疾病。然而，治疗方法仍存在争议。在过去的十年中，针对皮质类固醇使用的临床试验呈爆炸式增长，并引入了其他治疗考虑因素，包括两种新批准用于 IgAN 的治疗方法。钠-葡萄糖共转运蛋白 2 抑制剂在蛋白尿性慢性肾脏病中被证明是有效的治疗方法，IgAN 也不太可能例外。进一步的支持性药物和专门针对该疾病病理生理学的新型药物都极具前景，包括内皮素阻断、补体抑制和 B 细胞靶向策略。我们提出了一种目前治疗 IgAN 患者的方法，揭示了我们知识中的局限性，并讨论了可能出现的新治疗方法，希望这些方法能提供关于最佳利用的证据。我们治疗 IgA 肾病的方法似乎不可避免地会发生变化。这确实是一个令人兴奋和乐观的时期。
