Treatment of primary IgA nephropathy. Part 1. Supportive therapy

IgA nephropathy (IgAN), the most common form of chronic glomerulonephritis, may be associated with unfavorable longterm outcomes. Recently, new agents slowing the progression of the disease and improving kidney survival have been developed. Supportive therapy with antihypertensive drugs and renin-angiotensin-aldosterone system (RAAS) blockers remains the first line treatment in patients without rapidly progressive glomerulonephritis. Most patients receive angiotensin-converting enzyme inhibitors and angiotensin receptor blockers that reduce proteinuria, whereas the data regarding their effects on renal function were contradictory. Post-hoc analysis of the randomized trials showed that sodium-glucose cotransporter 2 inhibitors may improve kidney outcomes in patients with IgAN. Nephroprotective effect of sparsentan and atrasentan, endothelin type A receptor blockers, was also shown in clinical trials. The use of finerenone, mineralocorticoid receptor antagonist, or aldosterone synthase inhibitors seems to be the promising approach, although their efficacy was studied only in patients with chronic kidney disease. Inability of supportive therapy to achieve target proteinuria and glomerular filtration rate decline in a significant proportion of patients with IgAN justifies the concomitant use of immunosuppressive agens to slow the progression of the disease.