Evolution of Views on Pathogenesis and Treatment of Immunoglobulin A-Nephropathy: What’s New Today?

Immunoglobulin A nephropathy is the most common immune glomerulopathy in the world. Significant evolution of views on the pathogenesis and treatment of the disease is especially noticeable in recent years due to the emergence of new data on the pathogenesis. It has been proven that immunoglobulin A nephropathy develops as a result of changes in the immune response of the mucous membranes, primarily the nasopharynx (tonsillitis) and gastrointestinal tract. The Russian population of patients is distinguished by its high prevalence, more significant clinical and morphological manifestations and rates of progression, higher proteinuria and prevalence of arterial hypertension and lower renal survival than in Asian and European populations. Immunoglobulin A nephropathy is one of the causes of terminal renal failure and the need for renal replacement therapy using dialysis and kidney transplantation, which requires a more active approach to therapy. The basis for managing patients with immunoglobulin A nephropathy, in accordance with clinical guidelines, is supportive therapy, including lifestyle changes, dietary correction, and drug therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors and sodium-glucose cotransporter type 2 (SGLT2) inhibitors. Treatment methods that reduce glomerular inflammation include immunomodulatory and anti-inflammatory therapy. This lecture presents modern views on pathogenesis, diagnostics, and treatment (including tonsillectomy, fish oil, and various immunosuppressive therapy methods) based on clinical research results.