Management of IgA Nephropathy

Introduction to IgA Nephropathy

The Kidney International journal recommends that NSAIDs like aceclofenac are contraindicated in patients with IgA nephropathy due to its potential to worsen kidney function and interfere with recommended treatments for this condition 1, 2

NSAIDs like aceclofenac can worsen kidney function in patients with glomerular diseases, particularly in those with already compromised renal function 1
The American Journal of Kidney Diseases states that NSAIDs interfere with the beneficial effects of ACE inhibitors and ARBs, which are cornerstone therapies for IgA nephropathy 2, 3
NSAIDs may increase proteinuria, which is a key marker of disease progression in IgA nephropathy 1, 4

Optimized supportive care is the primary focus of IgA nephropathy management, according to the Kidney International journal 2, 4
The American Journal of Kidney Diseases recommends that RAS blockade with ACE inhibitors or ARBs should be instituted for all patients with proteinuria >0.5 g/d, regardless of hypertension status (Grade 1B) 3
Blood pressure targets should be <130/80 mmHg for patients with proteinuria <1 g/d and <125/75 mmHg for those with proteinuria >1 g/d, as stated by the American Journal of Kidney Diseases 3
Proteinuria reduction to under 1 g/d is a surrogate marker of improved kidney outcomes and a reasonable treatment target, according to the Kidney International journal 1, 6

Patients with persistent proteinuria >1 g/d despite 3 months of optimized supportive care are considered high-risk for progression, as stated by the Kidney International journal 1, 4
For these patients, a 6-month course of glucocorticoid therapy may be considered if eGFR is >50 ml/min/1.73 m² (Grade 2B), according to the Kidney International journal and the American Journal of Kidney Diseases 2, 7

Azathioprine (except after cyclophosphamide in crescentic disease) should be avoided, as stated by the American Journal of Kidney Diseases 5
Cyclophosphamide (except in rapidly progressive disease) should be avoided, according to the Kidney International journal and the American Journal of Kidney Diseases 1, 5
Calcineurin inhibitors should be avoided, as stated by the Kidney International journal 1
Rituximab should be avoided, according to the Kidney International journal 1
Mycophenolate mofetil (except possibly in Chinese patients) should be avoided, as stated by the Kidney International journal 1, 6

Failing to optimize RAS blockade before considering immunosuppression should be avoided, according to the Kidney International journal 2
Not monitoring for proteinuria reduction as a surrogate marker of treatment success should be avoided, as stated by the Kidney International journal 1, 6
Overlooking the importance of blood pressure control as part of supportive care should be avoided, according to the American Journal of Kidney Diseases 3
Initiating immunosuppressive therapy in patients with eGFR <30 ml/min/1.73 m² (unless rapidly progressive disease) should be avoided, as stated by the American Journal of Kidney Diseases 5, 3