Treatment of primary IgA nephropathy Part 2. Immune suppressive therapy

IgA nephropathy (IgAN) is a common form of chronic glomerulonephritis that is associated with unfavorable long-term outcomes. Currently, approaches to management for IgAN undergo a significant transformation. According to modern concepts, treatment should be initially aimed not only at the consequences of nephron loss (maintenance therapy), but also at suppressing the main immune-mediated mechanisms of kidney damage. The article reviews the existing and emerging evidenceased approaches to immunosuppressive therapy for IgAN. Systemic glucocorticoids can reduce the risk of unfavorable disease outcomes in the short term, but are associated with adverse events. Nefecon, a targeted-release budesonide with an immunomodulatory effect, has demonstrated its effectiveness in reducing proteinuria and slowing the progression of estimated glomerular filtration rate decline. Despite the ineffectiveness of rituximab, anti-B-cell therapy targeting BAFF and APRIL is one of the most promising options. Complement inhibitors that block the proximal cascade of the alternative pathway and those acting on the terminal cascade have shown high efficacy, mostly in phase 2 studies. Thus, in the coming years, we should expect a significant expansion of the spectrum of therapeutic options for the treatment of IgAN, which for the first time since the discovery of the disease will allow the development of finely personalized approaches to patient management.