IgA nephropathy (IgAN) is the most common type of glomerulonephritis in Asia and the Western world. In most patients, it follows an asymptomatic to oligosymptomatic course and GFR loss, if any, is slow. The mainstay of therapy therefore is optimized supportive care, i.e., measures that lower blood pressure, reduce proteinuria, minimize lifestyle risk factors, and otherwise help to reduce non-specific insults to the kidneys. The value of immunosuppression has become controversial and if at all, systemic high-dose corticosteroid therapy should be considered for a few months taking into account patient characteristics that would caution against or preclude such therapy. In addition, adverse events related to corticosteroid therapy markedly increase as GFR declines. Beyond corticosteroids, there is little evidence that any additional immunosuppression is helpful, with the exception of mycophenolate mofetil in patients of Asian descent. A considerable number of clinical trials ranging from enteric coated budesonide to blockade of B-cell function to complement inhibitors are currently ongoing and will hopefully allow a more targeted therapy of high-risk patients with progressive IgAN in the future.

IgA 肾病 (IgAN) 是亚洲和西方世界最常见的肾小球肾炎类型。在大多数患者中，它遵循无症状到无症状的过程，并且 GFR 下降（如果有的话）是缓慢的。因此，治疗的支柱是优化的支持性护理，即降低血压、减少蛋白尿、最大限度地减少生活方式风险因素以及以其他方式帮助减少对肾脏的非特异性损伤的措施。免疫抑制的价值已引起争议，如果有的话，应考虑几个月的全身性大剂量皮质类固醇治疗，同时考虑到会警告或排除此类治疗的患者特征。此外，与皮质类固醇治疗相关的不良事件随着 GFR 下降而显着增加。除了皮质类固醇，几乎没有证据表明任何额外的免疫抑制是有帮助的，除了亚裔患者的霉酚酸酯外。目前正在进行大量临床试验，从肠溶布地奈德到阻断 B 细胞功能再到补体抑制剂，这些临床试验有望在未来对进展性 IgAN 的高危患者进行更有针对性的治疗。