ISN-Cochrane Webinar: Non-immunosuppressive treatment for IgA nephropathy

IgA nephropathy (IgAN) is the most common primary glomerulonephritis, with approximately 30% of patients progressing to kidney failure. This is an updated Cochrane systematic review of randomised controlled trials of non-immunosuppressive treatment in IgAN.  

Eighty studies (4856 participants) were identified. Most studies were at high or unclear risk of bias for most methodological domains. Renin-angiotensin system (RAS) inhibition probably decrease proteinuria but made little or no difference to kidney failure or doubling of serum creatinine. Tonsillectomy may decrease proteinuria compared to standard care alone but anticoagulant therapy, fish oil, and traditional Chinese medicines exhibited little or no effect on proteinuria.  

Learning objectives:

- Evaluate the benefits and potential harms of non-immunosuppressive treatments for the prevention and management of kidney disease in individuals with IgA vasculitis (IgAV), with or without kidney involvement at onset.
- Analyze the clinical implications of recent research findings for the management and treatment strategies of IgA nephropathy (IgAN).
- Identify key gaps in current knowledge and propose directions for future research to advance the understanding and treatment of IgAN.

Further reading:

- Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM, Cook HT, Fervenza FC, Gibson KL, Glassock RJ, Jayne DR. Executive summary of the KDIGO 2021 guideline for the management of glomerular diseases. Kidney international. 2021;100(4):753-79. 

- Li PK, Leung CB, Chow KM, Cheng YL, Fung SK, Mak SK, et al. Hong Kong study using valsartan in IgA nephropathy (HKVIN): a double-blind, randomized, placebo-controlled study. American Journal of Kidney Diseases 2006;47(5):751-60 

- Coppo R, Peruzzi L, Amore A, Piccoli A, Cochat P, Stone R, et al. IgACE: a placebo-controlled, randomized trial of angiotensin converting enzyme inhibitors in children and young people with IgA nephropathy and moderate proteinuria. Journal of the American Society of Nephrology 2007;18(6):1880-8

- Donadio JV Jr, Bergstralh EJ, Offord KP, Spencer DC, Holley KE. A controlled trial of fish oil in IgA nephropathy. Mayo Nephrology Collaborative Group. New England Journal of Medicine 1994;331(18):1194-9.

- Yang D, He L, Peng X, Liu H, Peng Y, Yuan S, et al. The efficacy of tonsillectomy on clinical remission and relapse in patients with IgA nephropathy: a randomized controlled trial. Renal Failure 2016;38(2):242-8

- Rovin BH, Barratt J, Heerspink HJ, Alpers CE, Bieler S, Chae DW, et al. Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial. Lancet 2023;402(10417):2077-90

- Carter SA, Lightstone L, Cattran D, Bagga A, Barbour SJ, Barratt J, et al. Standardized Outcomes in Nephrology Glomerular Disease (SONG-GD): establishing a core outcome set for trials in patients with glomerular disease. Kidney International 2019;95(6):1280-3

- Natale P, Palmer SC, Ruospo M, Saglimbene VM, Craig JC, Vecchio M, et al. Immunosuppressive agents for treating IgA nephropathy. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No: CD003965. [DOI: 10.1002/14651858.CD003965.pub3]