Immunoglobulin A nephropathy: fish oils and beyond.

There is no specific treatment to reduce glomerular IgA deposition in IgA nephropathy. The available controlled trials are restricted to patients with proteinuria and progressive renal failure where mechanisms of injury are common to other chronic glomerular diseases. Control of blood pressure is vital, but there is no conclusive evidence that angiotensin-converting enzyme inhibitors are the agents of choice. Fish oil appears to be beneficial, but the available trial data are not entirely consistent. Immunosuppressive regimens based on corticosteroids and cytotoxic agents may be beneficial, but there is concern over long-term toxicity. Angiotensin-converting enzyme gene polymorphisms may identify cohorts who are at special risk of progressive renal failure for recruitment into future trials.