Optimal Conservative Therapy Use Among Adult Cure Glomerulonephropathy Participants with Immunoglobulin A Nephropathy

What is it about?

We sought to ascertain the use of robust optimal conservative therapy in patients with immunoglobulin A nephropathy at enrollment and subsequent follow up in the Cure Glomerulopathy Network study

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Why is it important?

Immunoglobulin A nephropathy (IgAN) is an autoimmune condition affecting the kidneys. Typically, blood and protein are detected in the urine in IgAN. The diagnosis requires confirmation by performing a kidney biopsy. Up to 40% of IgAN patients progress to kidney failure needing dialysis within 20 years of diagnosis. Factors associated with poor outcomes include persistent urinary protein loss (especially more than 1 gram per day), poorly controlled blood pressures, and impaired kidney function. Clinical outcomes significantly improve if the protein loss in the urine can be lowered to at least less than 1 gram per day. The cornerstone of treatment consists of robust supportive lifestyle measures including blood pressure control, preferential use of medications known as renin-angiotensin-aldosterone-system (RAAS) inhibitors that play an important role in reducing urine protein and control blood pressure, and treatment of high cholesterol. Per current guidelines, patients with persistent urinary protein loss more than 1 gram per day despite above mentioned treatment efforts, additional medications (like glucocorticoids) or enrollment in clinical trials should be considered. Our study aimed to assess how well supportive measures were implemented among adults with IgAN at the beginning of joining the National Institutes of Health (NIH)-sponsored Cure Glomerulonephropathy Network (CureGN) study. Additionally, we aimed to see if the implementation improved over the six years of follow-up available. We found that about 30% of patients with IgAN had suboptimal control of blood pressure, urine protein levels, and use of RAAS inhibitors. These numbers remained steady over the 6 years of follow-up. Sixty percent of patients tested had high cholesterol. About 10% of patients remain at high risk of disease progression despite optimal supportive care. As such, these could potentially benefit from clinical trial participation and use of newly emerging therapies for IgAN.